Are you over 18 years of age?*

Yes

Are you legally eligible for employment in the USA?*

Yes

Please List Two Personal References (No Family Please)

Reference I

Reference II

Can we run a detailed employment check, including but not limited to previous employers?*

Yes

Education

Highschool

College/University

Other

Have you ever been debarred, excluded or otherwise deemed ineligible from participation in a federal or state health care program?*

Yes

Have you ever defaulted on health education loan or scholarship?*

Yes

As of July 1st, 2010 , convictions from Felony theft will be prohibited from employment pursuant to K.S.A. 39-970 and K.S.A. 65-5117.

Have you ever been debarred, excluded or otherwise deemed ineligible from participation in a federal care program? *

Yes

Have you ever defaulted on a health education loan or scholarship?*

Yes

Please read this list of offenses Click Here: Do you have any criminal charges, verified or pending? (As of July 1/2010 convictions from Felony theft will be prohibited from employment pursuant to K.S.A. 39-970 and K.S.A 65-5117):*

List Employment History starting with most recent or current job first.

Employer I

Employer II

Employer III

I UNDERSTAND, I MAY NOT BE HIRED OR MAY BE TERMINATED ONCE I HAVE BEEN HIRED BECAUSE OF CRIMINAL BACKGROUND CHECKS. I UNDERSTAND THAT I MUST PASS A DRUG SCREEN AFTER A CONDITIONAL OFFER OF EMPLOYMENT BEFORE I AM OFFICIALLY HIRED AS AN EMPLOYEE OF THE CEDARS. I UNDERSTAND THAT I MAY NOT BE HIRED UNTIL ALL REFERENCES HAVE BEEN CONTACTED. READ THIS SECTION PRIOR TO PROVIDING SIGNATURE: In consideration of my employment, I agree to conform to the rules and regulations of this facility. I understand that my employment can be terminated at any time and for any reason, at the option of either the facility or myself with or without cause. I understand that no one has the authority to enter into any agreement for employment for any specific period or make any agreement contrary to the foregoing, except for a written agreement signed by the administrative representative of the facility. I hereby affirm that the information on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I authorize any and all individuals, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying resume, if any) to provide this facility and all affiliates with any relevant information regarding employment decision and I release and agree to hold harmless all such parties from any liability regarding the release of any information or use of such information. THE CEDARS, INC. 1021 CEDARS DRIVE, MCPHERSON KANSAS IS AN EQUAL OPPORTUNITY EMPLOYER.

Employment Application