PI Coord, RN

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Additional Information

Please Note: We comply with the Americans with Disabilities Act (ADA) and provide reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination and to skill and agility tests. Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?

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Resume and Questions

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Work and Education History

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Education History

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I give permission for a pre-employment drug/alcohol screening exam, and, if Henry Mayo makes a conditional job offer, I give permission for a complete employment physical examination. I also consent to the appropriate release of any and all medical information, as may be deemed necessary. I hereby release Henry Mayo, any individual participant in said examination, and any third party from potential liability arising out of the examination.


I authorize Henry Mayo and its representatives, employees, and agents to investigate my background, including, but not limited to, my references, educational record, records maintained by both public and private organizations, work history and other matters related to my suitability for employment. This information includes, but is not limited to, my work achievements, performance, attendance, disciplinary history, salary record, personal and criminal history. I authorize and direct all former schools and employers, and any other individual or entity that possesses such information about my background, to release such information, regardless of any prior agreement to the contrary. I also authorize disclosure of all transcripts, reports, letters and other education or work records without prior notice to me. I release all schools, past and present employers, and all other individuals and entities from all liability for responding in good faith to any such request.


If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of Henry Mayo.


I understand and agree that nothing contained in this application, or conveyed during any interview which may be granted, or during my employment if hired, is intended to create an employment contract between me and Henry Mayo. In addition, I understand and agree that if you employ me, in consideration of my employment, my employment will be at-will, for no definite or determinable period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time, with or without notice, and with or without cause, and agree that no promises or representations contrary to the foregoing are binding on Henry Mayo unless made in writing and signed by me and an authorized officer of Henry Mayo.

By my signature I declare that I have personally completed this application or had this application completed on my behalf. I declare under penalty of perjury that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment if discovered at a later date. I agree to immediately notify Henry Mayo if I should be convicted of a crime while my job application is pending, or during my employment if hired.

Candidate Sign Off

I certify that all of the information in this application is true and correct as of this date.

NOTICE: Thank you for your interest in employment opportunities and for completing this application form. If there is a current opening for the position(s) you are seeking and the information in your application suggests you meet minimum qualifications and are among the best qualified candidates for that position, you may be contacted for an interview. If there is no opening in the position(s) you are seeking, your application will be kept active for six months.

Application Review