Benson Hospital - Application for Employment

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I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contact between Benson Hospital and me for either employment or for the providing of any benefit. If I am offered and accept employment, I understand that the employment is for no definite period of time and maybe (regardless of the date and payment of my wages and/or salary) terminated at any time, with or without cause. I understand that if Benson Hospital employs me, I will be employed as an employee at will. I understand that, subject to Employer’s obligations under the Americans with Disability Act (ADA), I must meet all the physical standards established by Benson Hospital to perform the essential functions of any job for which I am offered employment. I understand that, if offered employment, I might be required as a condition of employment to take a physical examination. I also understand that, subject to Employer’s requirements under the ADA, during employment I might from time to time be subjected to physical examinations and/or physical ability test to demonstrate that I can perform the essential functions of my job, with or without reasonable accommodations. I understand that Benson Hospital may from time to time require that I take a drug and/or alcohol test as a condition of employment. Benson Hospital reserves the right to conduct searches on company property of employees and their personal property for alcohol, drugs, of for property which might belong to Benson Hospital. Benson Hospital also reserves the right to conduct searches of the company’s property, vehicles and/or equipment at any time. A refusal to submit to a company search can subject an employee to employment termination. Benson Hospital is an equal opportunity employer. Benson Hospital does not discriminate against applicants or employees because of their age, race, color, religion, national origin, sex, disability or on any other basis prohibited by law including but not limited to disabled veteran and/or veteran of the Vietnam era. I certify that the information contained in this application is true, complete and correct to the best of my knowledge, and understand that any false or misleading statements or omissions, whenever discovered, regarding this application are grounds for disqualification from further consideration of for dismissal from employment. If employed by Benson Hospital, I agree to conform to the guidelines and policies of the company, and understand that my employment is at-will and can be terminated at any time and for any reason by either party. Electronic Signature Agreement. By selecting the "Submit" Button, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application. By selecting "Submit" you consent to be legally bound by this applications conditions of employment. Your further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Benson Hospital, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing.


Voluntary Equal Opportunity Questionnaire

Qualified applicants are considered for and treated without regard to race, color, religion, national origin, citizenship, age, marital status, ancestry, physical-mental disability, medical condition, veteran status or sexual orientation. Solely to help us comply with federal and state Equal employment Opportunity record keeping, and other legal requirements, we invite you to complete the following information. Please note that completion of this form is voluntary. Refusal to complete this information will not subject you to adverse treatment, the information you provide is confidential and will be kept separate from your other applicant information. This information will be used for date reporting requirements and will not be considered in making any employment decisions.


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Notice of Rights Under Federal Conscience and Nondiscrimination Laws

TMC Health complies with applicable Federal health care conscience protection statutes, including the Church Amendments, 42 U.S.C. 300a–7; the Coats-Snowe Amendment, section 245 of the Public Health Service Act, 42 U.S.C. 238n; the Weldon Amendment, e.g., Consolidated Appropriations Act, 2023, Public Law 117–328, div. H, title V General Provisions, section 507(d)(1) (Dec. 29, 2022); Sections

1303(b)(1)(A), (b)(4), and (c)(2)(A), and 1411(b)(5)(A), and 1553 of the ACA, 42 U.S.C. 18023(b)(1)(A), (b)(4), and (c)(2)(A), 18081(b)(5)(A), and 18113; certain Medicare and Medicaid provisions, 42 U.S.C. 1320a– 1(h), 1320c–11, 1395i–5, 1395w–22(j)(3)(B), 1395x(e), 1395x(y)(1), 1395cc(f), 1396a(a), 1396a(w)(3), 1396u–2(b)(3)(B), 1397j–1(b), and 14406; the Helms, Biden, 1978, and 1985 Amendments, 22 U.S.C. 2151b(f), accord, e.g., Consolidated Appropriations Act, 2023, Public Law 117–328, div. K, title VII, section 7018 (Dec. 29, 2022); 22 U.S.C. 7631(d); 42 U.S.C. 280g–1(d), 290bb–36(f), 1396f, 1396s(c)(2)(B)(ii); 5106i(a)); and 29 U.S.C. 669(a)(5).


More information to help entities determine which statutes are applicable to them is available at https://www.hhs.gov/conscience/conscience-protections/index.html. You may have rights as a provider, patient, or other individual under these Federal statutes, which prohibit coercion or other discrimination on the basis of conscience, whether based on religious beliefs or moral convictions, in certain circumstances. If you believe that TMC Health has violated any of these provisions, you may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://www.hhs.gov/ocr/complaints/index.html or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1–800–368–1019, 800–537–7697 (TDD) or by email at ocrmail@hhs.gov.


Complaint forms and more information about Federal conscience protection laws are available at https://www.hhs.gov/conscience.


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