Employment Application Employment Application THIS APPLICATION MUST BE COMPLETED IN ITS ENTIRETY TO BE A VALID APPLICATION PersonalName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone Number (include Area Code)*Alternate Telephone NumberEmail* Position Desired*Date Available for EmploymentEmployment Interest Full Time Part Time Are there any days or hours you are not available?Have you previously been employed by or applied for a position at the Sweetwater Hospital Association? Yes No If yes, when and what position?Do you have any relatives employed by the Sweetwater Hospital Association? Yes No Can you provide proof that you are legally eligible for employment in the United States of America? Yes No Are you 18 years of age or older? Yes No Have you ever been convicted of a violation of the law except a minor traffic violation? (A conviction will not necessarily disqualify you from employment) Yes No If yes, state date, court and place where offense occurred.EducationHigh SchoolSchool Name & LocationGraduated Yes No Major & GPACollegeSchool Name & LocationGraduated Yes No Major & GPAGraduate SchoolSchool Name & LocationGraduated Yes No Major & GPAReferral SourceSource of Referral College / University Newspaper or Print Ad Current Employee Internet Ad Other If other specifyEmployment HistoryMost Recent EmployerAddressJob TitleSupervisorDescription of Work/DutiesReason for LeavingDates Employed FromDates Employed ToLast Pay RateMay we contact? Yes No NamePhoneEmployer 2 (If Applicable)EmployerAddressJob TitleSupervisorDescription of Work/DutiesReason for LeavingDates Employed FromDates Employed ToLast Pay RateMay we contact? Yes No NamePhoneEmployer 3 (If Applicable)EmployerAddressJob TitleSupervisorDescription of Work/DutiesReason for LeavingDates Employed FromDates Employed ToLast Pay RateMay we contact? Yes No NamePhoneProfessional References (Do not list relatives or previous employers, co-workers are acceptableList three reference we may contact who are qualified to evaluate your work abilities.Name & Position*Company*Phone*Name & PositionCompanyPhoneName & PositionCompanyPhoneTo All Applicants for EmploymentWe appreciate your interest in our organization as a place of employment. Your qualifications will be given careful consideration. It is our policy and practice to make employment decisions without regard to race, religion, gender, national origin, age, veteran status, disability, genetic information, or any other status or condition protected by applicable state or federal law, except where a bonafide occupational qualification applies. We comply with the Drug-Free Workplace Act of 1988.Job Applicant's Agreement and Certification"I certify that the information given by me in this application is true in all respects, and I agree that if the information is found to be false by any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information." "I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and that the company retains the same right." "If I am offered employment, I agree to submit to a physical examination whenever requested, and I understand my becoming employed and/or my continued employment are subject to the results of any physical examination related to my job duties in accordance with company policies and procedures" "I understand that if employed. policies, and rules which are issued are not conditions of employment and that the employer may revise policies or procedures in whole or in part, at any time." I understand that this application will be kept an active file for 60 days from the date of completion, after which time i would have to reapply in accordance with established company procedures. Signature*Today's Date*Upload Your ResumeAccepted file types: pdf, jpg, doc, xls, docx, Max. file size: 50 MB.CAPTCHA