Employment Application

Cass Community Health Foundation and Cass County Dental Clinic are Equal Opportunity employers and comply with all Federal and State laws prohibiting employment discrimination because of race, color, religion, sex, gender identity, age, national origin, pregnancy, sexual orientation, military status, disability, or any other characteristics protected by applicable law.

Please complete this employment application as completely and accurately as possible.

Please note all applications must be completed online. The system requires that you submit all information at the same time. You will not be able to start your application and come back to it at a later time.

Personal information
First Name *
Middle
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Check all schedules you are willing to work
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Education information
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Start Date
–
End Date
Professional information

Please include all employment references. These do not have to be related to the position you are applying for. List most recent position first.

Country
Address Line 1 *
City *
State/Province *
Postal Code *
Start Date
–
End Date
Can we contact this employer?

 

 

Country
Address Line 1
City
State/Province
Postal Code
Start Date
–
End Date
Can we contact this employer?

 

 

Country
Address Line 1
City
State/Province
Postal Code
Start Date
–
End Date
Can we contact this employer?

 

 

Professional memberships and registrations

Has your license ever been revoked or suspended?
Additional information
Have you ever been involuntarily discharged from a job?
Have you ever been sanctioned by Medicare, Medicaid, or any other regulating body for fraud or abuse?
Have you previously worked at the Cass Community Health Foundation or Cass County Dental Clinic?
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Please read before submitting application
I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree that my employer shall not be liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this questionnaire. I also understand a conditional offer of employment may be based on results of an Investigative background check and a later medical examination. The Cass Community Health Foundation/Cass County Dental Clinic is an equal opportunity employer. The Cass Community Health Foundation/Cass County Dental Clinic does not discriminate because of race, color, religion, sex, national origin, ancestry, disability, marital status or age in employment. I authorize any educational institution and my former employers to provide any information they may have regarding me in their records. I hereby release them, their employees and Cass Community Health Foundation/Cass County Dental Clinic from all liability for any damage whatsoever for providing or obtaining same. I agree if employed by Cass Community Health Foundation/Cass County Dental Clinic to be paid in accordance with the Fair Labor Standards Act. The law provides that an employee may be paid every two weeks. I hereby agree if employed by Cass Community Health Foundation/Cass County Dental Clinic to abide by the rules and policies of Cass Community Health Foundation/Cass County Dental Clinic. I understand that my application will remain in the active file for a period of one year from the date of application. The employee and Cass Community Health Foundation/Cass County Dental Clinic have a right to freely enter into the employment relationship and sever this relationship at any time for any reason. The Immigration Reform and Control Act of 1986 requires all employers to verify IDENTITY and EMPLOYMENT AUTHORIZATION for all employees. Further, I understand that any employment is not for a stated period of time and may be terminated with or without cause, at any time, at the option of either myself or my employer. In addition, should my employer be or become subject to the conditions of the Drug-Free Workplace Act of 1988, I agree to abide by such established policies as relates thereto.