All information must be filled out for all of your references, including both phone numbers and email addresses.
I, the undersigned, authorize and give consent for the Lac Vieux Desert Health Center, or any Agent acting on its behalf, to make inquires, collect, and use personal information concerning my current and past employment for the purpose of assessing my application for employment with the Lac Vieux Desert Health Center.
I, understand that if I am successful, this information will be retained in my personnel file within the Human Resource Office and disposed of according to the policy on personnel file retention and disposal. If I am unsuccessful, it will be destroyed in accordance with the health center’s policies.
I understand that the reference information may include but not limited to, verbal, written and digital inquiries or information about my employment performance, professional demeanor, and character, rehire potential, dates of employment, salary, and employment history. By providing such authorization, I understand and agree that I release the Lac Vieux Desert Health Center from any and all claims or potential claims I may have regarding any and all information released to or by the Lac Vieux Desert Health Center and regarding any employment decisions made about me on the basis of such information.