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Coding Specialist
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Additional Information

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Have you ever worked for St. Dominic Hospital, St. Catherine's Village, or Medical Associates before?

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RELEASE AUTHORIZATION AND
FAIR CREDIT REPORTING ACT DISCLOSURE

[FOR EMPLOYMENT PURPOSES]

The applicant for employment acknowledges that St. Dominic Hospital and Health Services may now, or at any time while employed, verify information within the application, resume or contract for employment.  In the event that information from the report is utilized in whole or in part in making an adverse decision, before making the adverse decision, we will provide to you a copy of the consumer report and a description in writing of your rights under the Fair Credit Reporting Act,15 U.S.C. § 1681 et seq.

Please be advised that we may also obtain an investigative consumer report including information as to your character, general reputation, personal characteristics, and mode of living.  This information may be obtained by contacting your present and previous employers or references supplied by you.  Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested.

All potential employees will be tested for drugs/alcohol as part of the post-offer physical examination. The results of which will be reported to Human Resources.

All potential employees shall be fingerprinted and a criminal history record check performed.

If employed I agree to abide by the policies and procedures of St. Dominic.

I understand that St. Dominic is a tobacco free environment and that the use of tobacco products is not permitted during the work shift.

I understand that annual influenza vaccination is mandated for all employees of St. Dominic and its related and affiliated corporations, and independent contractors who will be on St. Dominic owned or operated properties.  

By signing below, the applicant certifies that all statements made in the employment application are true and the applicant acknowledges that any falsification may be sufficient cause for termination or refusal to hire.

Additional information concerning the Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq., is available at the Federal Trade Commission’s web site (http://www.ftc.gov).

By signing, I hereby authorize all entities having information about me, including present and former employers, personal references, criminal justice agencies, departments of motor vehicles, schools, licensing agencies, and credit reporting agencies, to release such information to the company or any of its affiliates or carriers.  I acknowledge and agree that this Release and Authorization shall remain valid and in effect during the term of my employment. 

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