Position Information

Education and Training

Professional Credentials/Affiliations

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Health Care Specialty

Please list area and years of experience for each health care specialty.

General Information

Employment History

Professional References

List three individuals - minimum of two supervisory references. 3 references are required for application.

AGREEMENT

By signing below, I certify that the information I have provided on this application is true and correct to the best of my knowledge, and I understand that any misrepresentation or willful omission of facts shall be cause for rejection of this application or termination. I also certify that I have read, understand, and authorize any person, agency, or other entity contacted by Baylor Scott & White Medical Center - Frisco or its agents to furnish the information listed below. I hereby authorize Baylor Scott & White Medical Center - Frisco to conduct work history, education, personal reference or police record inquiries to determine my acceptability for employment. I authorize Baylor Scott & White Medical Center - Frisco and its agents to procure a consumer report and/or investigate consumer report about my background, character or reputation, including but not limited to information as to my employment, education, consumer credit history (if appropriate for certain job descriptions), driving record, social security number verification, criminal record, and/or other public record history. I authorize all persons to fully disclose information relevant to this investigation. I release from liability all persons, companies, and government or other agencies disclosing such information. If further authorize a photocopy of this authorization to be considered an original. I understand that this employer agrees that it will provide workers' compensation insurance coverage for its employees. In the event of an injury in the workplace, I agree that my sole remedy lies in coverage under this employer's workers' compensation insurance policy. I understand, and agree that as a condition of employment, I will be required to submit to an employment physical examination and a drug screen, and other physical examinations consistent with law during my employment at Baylor Scott & White Medical Center - Frisco. I may, at the discretion of Baylor Scott & White Medical Center - Frisco be required to submit to a drug screen upon request during my employment. I further agree, if employed, to observe all rules, regulations and policies of Baylor Scott & White Medical Center - Frisco. Additionally, I comprehend Baylor Scott & White Medical Center - Frisco commitment to its Code of Conduct, Compliance Plan and anti-harassment policies and further agree, if employed, to carefully review and abide by these policies. If I am employed at Baylor Scott & White Medical Center - Frisco, I understand that my employment can be terminated without cause and without notice, at any time, at the option of Baylor Scott & White Medical Center - Frisco.