MD ImagingUltrasound Technologist Application

We are an Equal Opportunity Employer

Employment Desired*

Position(s) applying for:

Name*

First Middle Last

Present Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Home Phone

Email*

Have you ever applied to or worked for our Company before?*

Yes
No

When and which position?*

Do you have any friends or relatives working for MD Imaging?*

Yes
No

Please provide name(s) and relationship(s)*

How did you learn about our Company?*

If hired, would you have a reliable means of transportation to and from work?*

Yes
No

Are you at least 18 years old?*

Yes
No

If under 18, hire is subject to verification that you are of minimum legal age.

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?*

Yes
No

Are you able to perform the essential functions of the job with or without reasonable accommodations?*

Yes
No

If no, describe the functions that cannot be performed.*

We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.

Education, Training and Experience*

School Name	Location	No. of years completed	Did you graduate?	Degree or Diploma

Include high school and any college, university, trade school, or other education and training you have received.

Employment History

Dates of employment	Name of company	Address of company	Position Title and Responsibilities	Name of supervisor	Phone of supervisor	Reason for leaving	May we contact this employer?	Actions

There are no Entries.

File Upload

Drop files here or

Max. file size: 60 MB, Max. files: 50.

Include any relevant files including your résumè

I hereby certify that all the information above is true and complete. I have not knowingly withheld any information that might adversely affect my chances for employment. I understand that any falsification, material omission or misstatement of information on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I further certify that I, the undersigned applicant, have personally completed this application.*

I agree

I understand that any offer of employment will be conditioned upon complying with all of the Company’s requirements including, but not limited to, signing any requested consent for the Company to conduct an investigation or obtain a report about my background.*

I agree

I hereby authorize MD Imaging, and its representatives to contact my prior employers and all others for the purpose of verification of all information I have supplied, and to thoroughly investigate my references, work record, education, professional credentials, and other matters related to my suitability for employment. Further, I authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure*

I agree

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is “at-will” – that is, it is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative.*

I agree

I understand an offer of employment may be made contingent on passing a job-related physical examination. I agree to submit to a controlled substances screening and physical examination by the Company’s designated medical practitioner and at the Company’s expense upon receiving a conditional offer of employment from the Company.*

I agree

Privacy*

I agree to the privacy policy.

California Consumer Privacy Act Notice for Applicants

MD IMAGING, including its subsidiaries and affiliates (collectively, “MD Imaging”, “we”, “us”, or “our”), is committed to ensuring the protection of Personal Information submitted to us in the job application or placement process. This California Residents’ Notice (“Notice”) describes what Personal Information we collect, how it is processed, and the rights and obligations you may have in connection with it.
1. INFORMATION WE COLLECT ABOUT JOB APPLICANTS
MD IMAGING may collect the personal information described below that identifies, relates to, describes, references, is capable of being associated with, or could reasonably be linked, directly or indirectly with you (“Personal Information”) for business purposes as part of your employment application with MD IMAGING. We will not collect additional categories of Personal Information or use it for purposes beyond the scope of those identified below without obtaining consent.
(a) Identifiers and demographic data. This includes data such as title, full name, gender, age, contact details, such as current and prior home and work address, phone number(s), email address(es), your geographic preferences for the location of employment, driver’s license details, proof of eligibility to work and details of any work permit application, including biometric data.
(b) Sensitive data. This includes data like financial account numbers, Social Security, Driver’s License, Passport, or other governmental identification number, medical or health related information, biometric data, performance reviews, etc. collected for business purposes.
(c) Characteristics of protected classifications under California and Federal law. This includes but is not limited to data such as citizenship, race, ethnic origin, or nationality.
(d) Professional or employment-related information. This includes information such as work history, prior employer information, and professional certifications.
(e) Non-public education information. This is information related to your academic credentials such as what school you went to, what your GPA was, what activities or sports you did in school, or other data on your school transcripts.
Personal Information does not include publicly available information, i.e., information that is lawfully made available from federal, state, or local government records. Personal Information does not include information that is de-identified or aggregate consumer information.
2. WHERE WE GET YOUR PERSONAL INFORMATION
MD IMAGING obtains the categories of Personal Information listed above from the following categories of sources:
· Directly from you. For example, from forms you complete or products and services you purchase (if any).
· From prior employers, references, recruiters, recruitment agencies and job-related social media platforms.
· From independent third parties related to your eligibility for employment, such as background check companies and drug testing facilities.
3. USE OF YOUR PERSONAL INFORMATION
MD IMAGING will process your Personal Information for the purposes listed below, primarily related to your employment application and, if you are hired, for employment-related purposes, including:
(a) Recruitment, including, verifying eligibility to work, obtaining professional and personal references and screening of educational and professional background data prior to and during the course of the interviewing process and employment, including carrying out criminal record checks (where permitted under applicable law).
(b) Assessing your suitability for employment with MD IMAGING.
(c) Verifying certain information about you.
(d) Conducting application and employment-related statistical analyses.
(e) Communicating with you during the hiring process and, if hired, during employment.
(f) Compliance with all relevant legal, regulatory, and administrative obligations and responsibilities of MD IMAGING.
(g) Conducting exit interviews.
(h) For a purpose described to you when collecting your Personal Information.

We will not collect additional categories of Personal Information or use the Personal Information we collected for materially different, unrelated, or incompatible purposes without providing you notice.
4. HOW WE DISCLOSE YOUR PERSONAL INFORMATION
Within our MD Imaging and group of companies:
Because we have operations in many different locations, we may transfer your information from one legal entity to another or from one location to another in order to accomplish purposes listed in this Notice (including those for which we retain service providers as described below). We will transfer your personal information in a manner that is consistent with applicable legal requirements.
With third parties:
We may disclose your Personal Information to a third party for a business purpose. A business purpose means the use of Personal Information for MD Imaging’s operational purposes or business needs that are reasonably necessary and proportionate to achieve the purpose for which information was collected. For purposes of job applicant information, examples of Business Purposes include, but are not limited to:
(1) Recruiting;
(2) Background and criminal history checks;
(3) Selection and administration of the workforce;
(2) Business operations and human resources administration;
(3) Ensuring the security, safety and protection of workers and resources; and
(4) Legal, regulatory and audit obligations.

When we disclose Personal Information for a business purpose, we enter into a contract that describes the purpose and requires the recipient to both keep that Personal Information confidential and not use it for any purpose except when performing the contract. These third parties are “Service Providers” and/or “Contractors” as defined by applicable law.
We may also disclose your Personal Information to another MD Imaging as part of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our assets to that MD Imaging; or where required by MD IMAGING policy, law, or in response to valid legal process compelling disclosure.
We disclose your Personal Information for business purposes only to Service Providers and/or Contractors, where required by law, or in response to valid legal process compelling disclosure.
5. SELLING YOUR PERSONAL INFORMATION
MD IMAGING does not and will not sell your Personal Information.
6. RETENTION OF YOUR PERSONAL INFORMATION
MD IMAGING retains Personal Information about you for business purposes; this information is retained pursuant to our Records Retention Schedule. Our customary retention of job applicant information is a period of years after a hiring decision is made or after an individual terminates or retires from employment, except when a legal obligation to preserve information exists.
7. CALIFORNIA RESIDENTS’ RIGHTS
If you are a California resident, you have a right to inquire about the personal information we collect, use, disclose and sell about you and the right to request deletion, subject to certain limitations. Please see "Inquiries" section below for information on how to exercise such rights.
You may also access or change certain application or candidate information by sending an email to humanresources@mdimaging.net. To report problems with the application website or to pose questions or concerns, contact us by emailing humanresources@mdimaging.net.
8. APPLICABILITY
We reserve the right to amend this Notice from time to time at MD IMAGING’S discretion.
9. MD IMAGING’S PRIVACY POLICY
A copy of MD IMAGING’s Privacy Policy can be found in our employee handbook or a requested copy from humanresources@mdimaging.net.
10. INQUIRIES
For any inquiries, questions or concerns you have about this Notice, please contact us at:
530-243-1249 number or humanresources@mdimaging.net.

Hidden

Date

Printed Name

Signature

CAPTCHA

Application for Ultrasound Technologist