Please Read and Sign
I voluntarily authorize Good Samaritan to make a thorough pre-employment investigation, including a limited criminal history background check for the purpose of qualifying for a Good Samaritan Nursing Scholarship. I understand that I have the right to obtain a copy of that report at my own expense and to challenge any information that I believe to be inaccurate. I hereby authorize former and present employers and others to provide or verify any information they have regarding my employment or me and release them from any liability for furnishing such information to Good Samaritan. I understand that scholarship qualification and employment is contingent on satisfactory outcomes of reference and background checks.
The information in this document that I have provided is true and complete, and I have met the eligibility requirements of the program as described. False statements on this scholarship application and employment-related documents shall be considered sufficient cause for denial of scholarship qualification. Falsification of information may result in termination of any scholarship granted upon discovery of such falsification. If I receive a Good Samaritan Nursing Scholarship and an offer for employment, I agree to have a medical evaluation and understand that any subsequent employment is contingent upon passing that evaluation. As an employee, I agree to take such future medical evaluation as may be lawfully required by Good Samaritan. If I am employed, I understand that I may be required to work weekends, holidays and overtime and hereby agree to do so. I agree to accept a temporary shift or unit change whenever emergency conditions warrant. If employed, I agree to abide by the policies, procedures and rules of Good Samaritan and the department to which I am assigned.
I further agree to protect the confidentiality and privacy of any information regarding Good Samaritan and its patients. I acknowledge that decisions of Good Samaritan and its Selection Committee are final. This application and its attachments become the property of Good Samaritan.