(If yes, verification will be required.)
(Some jobs may require a Class A, B, C or D license)
To be completed by applicants for labor and skilled trade positions
NOTICE TO APPLICANTS FOR EMPLOYMENT (Tennessen Warning)
Minnesota law requires that you be informed of the purposes and intended uses of the information you provide to the Olivia Hospital and Clinic during the application process or during employment. Any information about yourself that you provide to the Olivia Hospital and Clinic during the application process will be used to identify you as an applicant and to assess your qualifications for employment with Olivia Hospital and Clinic. If you wish to be considered for employment, you are required to provide the information requested in the Application for Employment. If you refuse to supply information requested by Olivia Hospital and Clinic, it may mean that your application will not be considered. You are hereby advised that, under Minnesota Law, the following information about you must be made available to any member of the public who requests it: Veterans Relevant Test Scores Rank on Eligible Lists Job History Education and Training Work Availability Your name will not be made available to the public unless you are selected to be interviewed by Olivia Hospital and Clinic. If you are selected to be interviewed by Olivia Hospital and Clinic, your name will also be made available to any member of the public who requests it. Other information about yourself that you provide during the application process or during employment with Olivia Hospital and Clinic is classified as private under state law, except as listed as public here or as listed in Minn. Stat. 13.01.Et seq.. That is, the information may not be provided to members of the public except: 1. persons authorized to have access to the information under state or federal law; and 2. persons authorized by court order to have access to the information; and 3. persons to whom you consent in writing to have access to information. All individuals in the county who need to know information will have access. The applicant (signature below) has read and understands the information contained in this document.
List present and past employers beginning with your most recent position
Names of any relative working for Olivia Hospital & Clinic