CCH
Are you legally authorized to work in the U.S.? —Please choose an option—NoYes
Have you ever worked for Castro County Hospital District? —Please choose an option—NoYes
Are you related to another facility employee? —Please choose an option—NoYes
Are you currently excluded from participating in any federally funded healthcare program – including Medicare and Medicaid – and are you aware of any potential exclusion from a federally funded health program? —Please choose an option—NoYes
Are you able to perform the essential, job related functions of the position for which you are applying with or without reasonable accommadations? —Please choose an option—NoYes
Have you been convicted of a crime and/or released from confinement following a conviction for any criminal offense? —Please choose an option—NoYes
If yes, give date, place and nature of each such conviction:
Are you presently charged with any violation of the law? —Please choose an option—NoYes
