Applicant Information
Position Related Information
Employment History








Certifications / Training

Professional References

Background Information Check

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I understand that if offered a position with Kansas Medical Center LLC, I may be required to submit to a pre-employment background check and a pre-employment drug test as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment checks will result in withdrawal of any employment offer or termination of employment if already employed.

Equal Opportunity Employment

Please note: It is the policy of Kansas Medical Center to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. As an equal opportunity employer under EO 11246 we invite all applicants to identify themselves as indicated below.

Completion of this form is voluntary and in no way affects the decision regarding your employment. This form is confidential and will be maintained separately from your application and personnel file.

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Autism
  • Bipolar Disorder
  • Post-Traumatic Stress Disorder
  • Deafness
  • Cerebral Palsy
  • Major Depression
  • Obsessive Compulsive Disorder
  • Cancer
  • Multiple Sclerosis
  • Impairments requiring the use of a wheelchair
  • Diabetes
  • Schizophrenia
  • Missing limbs or partially missing limbs
  • Intellectual disability (mental retardation)
  • Epilepsy
  • Muscular Dystrophy

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