Employment Application

Med Plus Health Care Employment Application


  • Factors such as federal statutory requirements, the relationship of the offense to employment, the length of time since the offense and the seriousness and nature of the violation will be taken into account.

  • EDUCATION (Please list school name & location)

  • or other legally protected categories. No question on this application is intended to be used for any unlawful purpose.


  • The information I’ve provided on this application is accurate and complete to the best of my knowledge and subject to verification by Med Plus HealthCare or any subsidiary or affiliate. I understand that any misrepresentation, omission or falsification of statements on this application or resume` will be justification for refusal to employ me or for termination of my employment without notice.

    I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I understand that should this application or criminal record check reveal a conviction of a crime of dishonesty or breach of trust, further processing of this application or employment may be terminated.

    I understand that I must undergo and pass a drug test as a condition of employment, and that if hired I can be discharged for failure to comply with Med Plus HealthCare or any subsidiary or affiliate’s policy of drug abuse. If employed I will be required to sign and abide by the Confidentiality Statement, policies, work performance and business conduct standards provided by Med Plus HealthCare.

    I understand that this employment application is not a contract of employment. I further understand that if hired I will be and employee at will and may voluntarily terminate my employment at any time and for any reason and may be terminated by the employer at any time for any reason.




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