Employment Application Disclaimer
Excel Medical Staffing does not discriminate on the basis of any legal-protected category and considers applicants for all positions without regard to race, color, religion, creed, national origin, age, disability, veteran status, gender, or sexual orientation.
You must fully and accurately complete the application for employment. Incomplete applications will not be considered. The staffing agency may use the information given in the application to verify the applicant's previous employment.
The staffing agency you are applying to conducts criminal record checks. Failure to divulge complete information will disqualify you from employment. However, conviction(s) will not necessarily disqualify an applicant from employment.
Please check the appropriate box for each question. If you answer "YES" to any of the following, please use the box provided to describe details.
| Question | YES | NO | Reason |
|---|---|---|---|
| Have you ever been convicted, pled guilty or no contest to a crime? This includes misdemeanors (except parking violations), gross misdemeanors and felonies. A conviction, guilty plea or no contest will not necessarily disqualify you for employment consideration. | |||
| Do you have any sanctions or limitations against any licenses you have or have had (including expired)? | |||
| Have you ever voluntarily or involuntarily relinquished any licenses? | |||
| Have you ever voluntarily or involuntarily been terminated by a healthcare facility? (This does NOT include proper notice of resignation.) | |||
| Do you have any professional liability actions resulting in a final judgment against you? | |||
| Have you ever been disciplined by professional or state ethics or licensing board or registered with IPN? | |||
| Have you ever been deemed a sex offender or sexual predator? Or have you been convicted of child abuse? |
I understand that, if any of the above questions are answered yes, the staffing agency has the right to deny this application.
I hereby certify that my answers appearing on this application are true. I understand that if any material information given in this application is found to be incorrect or incomplete, it may be grounds for immediate termination at the sole discretion of the staffing agency. I give the staffing agency the right to contact my previous employers for verification purposes.
I authorize the staffing agency to release any medical information required for employment to their client facilities. I understand that this information is scanned and posted on a secured website that is accessible to their client facilities and other affiliates of the staffing agency.
I understand that this application is not a contract of employment. I also understand and agree that, if hired, my employment would not be for a definite period and could be terminated at any time without prior notice, with or without any reason.
In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, education, educational background, and/or criminal history.
Typing your name above constitutes a legally binding digital signature.