Gynecologic Oncology Nurse Practitioner or Physician Assistant - UVMMC

Why are you being asked to complete this form?

• We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability.

Terms and Conditions

• I certify that the information provided here is true and correct. I understand that any incomplete, incorrect or false statement or misrepresentation may result in denial of employment or dismissal if I am hired. I further understand that The University of Vermont Health Network may make any necessary investigations into my personal history as it relates to my employment, through any investigative means. I hereby release The University of Vermont Health Network, and any persons or organizations that provide information, from all legal responsibilities or liability that may arise from said investigation.