Application Form

Employment History






I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by PMH&HS that such employment with PMH&HS is at will, for now specified duration and may be terminated by either PMH&HS or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of PMH&HS or its representatives used during the employment process is deemed a contract of employment real or implied.

In consideration for employment with PMH&HS, if employed, I agree to conform to the rules, regulations, policies and procedures of PMH&HS at all times and understand that such obedience is a condition of employment. I understand that if offered a position with PMH&HS, I will be required to submit to a pre-employment health assessment and background check 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 tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to PMH&HS and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. Upon employment, employee will receive compensations through direct deposit to a financial institute.

PMH&HS is an Equal Opportunity Employer and expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. If you have any questions or need further assistance, please contact Human Resources at 605-326-3028.


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