APPLICANT'S STATEMENT

I certify that the answers given in this application are true and complete and I authorize St. Mary's Hospital to investigate any or all statements made herein.  I understand that any falsification or omission of information will result in rejection and/or immediate termination.  I agree that my employment, and the terms and conditions thereof, may be modified or terminated at any time, at the discretion of my employer.  I agree as a condition of employment to conform to Hospital rules and regulations.

 I understand that employment is contingent upon favorable results of a drug screen analysis for substance abuse, successful completion of a physical assessment conducted by Hospital staff, receipt of acceptable references from previous employers, Consumer Investigative Report, meeting employability requirements of the Federal Immigration and Naturalization Service and submitting appropriate documentation to satisfy the requirements for completing INS FORM I-9.

Under Maryland Law, an employer may not require or demand any application for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment.  Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.