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La Casa Family Health Employment Application Form

Personal Information
Contact Information
Work Information


High School
Undergraduate School
Graduate School
Technical Knowledge
Special Skills and Licenses
Technology
Foreign Language's
Employment History
EMPLOYER 1
EMPLOYER 2
EMPLOYER 3
EMPLOYER 4
Transportation
References
REFERENCES 1
REFERENCES 2
REFERENCES 3
Service Record
OPTIONAL: Resume
Conviction Verification
APPLICATION FORM WAIVER

In exchange for the consideration of my job application by La Casa Family Health Center, I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relations, either in the position applied for or any other position, and regardless of the contents or employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time of time, or other La Casa Family Health Center practices, shall serve to create an actual or implied contract or employment, or to confer any right to remain an employee La Casa Family Health Center, or otherwise to change in any respect the employment-at-will relations between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Chief Executive Officer of La Casa Family Health Center. Both the undersigned and La Casa Family Health Center may end the employment relationship at any time, without specified notice or reason. If employed, I understand that La Casa Family Health Center may unilaterally without specified notice or reason. If employed, I understand that La Casa Family Health Center may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. 

I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give La Casa Family Health Center permission to contact schools, all previous employers (unless otherwise indicated), references, and others, and hereby release La Casa Family Health Center from any liability as a result of such contact.

I understand that, in connection with the routine processing of your employment application, La Casa Family Health Center will require a pre-employment drug screen. 

I understand that, in connection with the routine processing of your employment application, La Casa Family Health Center will conduct a background check.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. 

I further understand that my employment with La Casa Family Health Center shall be probationary for a period of one hundred and eighty (180) days, and further that at any time during the probationary period or thereafter, my employment relationship with La Casa Family Health Center is terminable at will for any reason by either party. 

Signature

This health center receives HHS funding and has Federal Public Health (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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Portales: (575) 356-6695
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ENMU Roswell: (575) 624-7106
Roswell Behavioral: (575) 755-2272