Consent Agreement and Disclosure Statement

As part of our commitment to quality and excellence, Sentara Healthcare will continue to maintain a safe, healthy environment for you by requiring all applicants to submit to a criminal history check and those tentatively selected for a position to submit to screening for illegal drug use prior to appointment for a job. In addition, applicants may be screened for ability to perform essential functions of some positions.

In light of this, we request that you read and accept the following Consent Agreement and Disclosure Statement.

As an applicant, I hereby acknowledge that if I have been convicted of a felony or misdemeanor of moral turpitude (excluding minor traffic violations), or I am subject to pending criminal charges for any of the following offenses within or outside the Commonwealth of Virginia, I may be ineligible for employment with Sentara Healthcare. Criminal offenses may include murder, abduction for immoral purposes, assault, battery, robbery, pandering, arson, crimes against nature involving children, taking indecent liberties with children, abuse and neglect of children, failure to secure medical attention for an injured child, sexual assault, obscenity offenses, crimes against the person, crimes against property, crimes involving fraud, crimes involving health and safety, crimes involving morals and decency, abuse or neglect of an incapacitated adult, crimes related to healthcare, listed by any Federal agency as debarred, excluded or ineligible for participation in federally funded health programs.

I also understand that if I have been convicted of a barrier crime, I cannot work for Sentara Life Care, Sentara Home Care, or Medical Transport, LLC. If I have been convicted of a healthcare-related crime or debarred, excluded or ineligible for participation in federally funded health programs, I understand that I am ineligible for employment with Sentara Healthcare.

I understand that final confirmation of any job offer will be contingent upon my undergoing a pre-employment drug screening, and that failure to submit to such screening, the falsification of a screen, or a positive finding on a test will remove me from consideration for employment for one year. I consent to the screening and will report for screening on the day assigned by Sentara Healthcare. I understand that final confirmation of employment is contingent on successfully completing the employee health examination as required by Sentara Healthcare.

I also understand that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and any violations of Sentara’s Drug-Free Workplace policy shall subject an employee to disciplinary action up to and including termination.

I also understand that some positions require an ability to meet physical demands that serve as the essential functions of the job. For these positions, I understand that I may be required to demonstrate that I can perform the essential functions of the job.

I understand that, if hired, I am required to complete a Sentara Healthcare orientation which is generally completed on Mondays by computer based training (CBT). I must also attend divisional and departmental orientation as scheduled.

Nothing herein creates either a contract or offer of employment. Although the information provided on this site is believed to be correct, it is not guaranteed.

I certify that statements provided by me are true. I understand that false or incomplete statements herein or the omission of any information requested, or inaccurate information I have submitted are grounds for dismissal. I agree that a thorough examination of my employment except as it pertains race, color, religion, ancestry, national origin, marital status, age, sex, sexual orientation, gender identity or expression, genetic information, physical or mental disability, pregnancy, medical condition, veteran status or any other legally protected characteristics may be made and used relative to my employment. I authorize my former employers and any other persons or organizations to provide any factual information they have about my employment and I release all concerned from any liability in connection therewith. If employment is offered, I understand that I may be required to work varied shifts, weekends and overtime. I understand that employment with Sentara Healthcare or any of its subsidiaries is terminable at either the will of the employee or employer at any time. Sentara Healthcare is an equal opportunity employer. Prior to the completion of the hiring process, I acknowledge that I may be required to sign a non-electronic form that confirms that all of the information I have provided Sentara Healthcare is correct.