Personal Information

    Are you a U.S. citizen?
    Are you authorized to work in the U.S.?
    Have you ever been convicted of a felony?
    Have you served in the U.S. military?

    Objective

     

    Locations

     

    Education

    Add any high schools, colleges, and trade schools.
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    Employment

    Add any past work experience.
    + Add Employer

    References

    Add your professional references. Do not include friends or relatives.
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    Do you have a reliable method of transportation to use if you are hired to work in this facility?
    Do you speak, read, or write any language other than English?
    Type of Position
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    Shift
    Please indicate the shift you are applying for:

    Available Positions

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    Paper Application

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    Paper Application (115,674 bytes)

    Authorization

    I understand that applicants who do not meet the minimum qualifications of the position will not be considered for the position. Only those final candidates will be contacted. I also understand that my employment is contingent upon a negative drug screen, clear background screen, and a minimum of two positive business reference.

    Please review and sign where indicated. In making application for employment:

    I certified that the information in this application is true and complete for all practical purposes. It may be verified by the facility or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that the facility or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate discharge without recourse.

    I understand that an investigative repo may be made by a consumer reporting agency to include information as to my character, general reputations, personal characteristics, and mode of living, whichever may be applicable, If such an investigative report is made, I understand that I will receive notice that such report has been requested, and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.

    I UNDERSTAND AND AGREE THAT ANY EMPLOYEE HANDBOOK WHICH I MAY RECEIVE WILL NOT CONSTITUTE AN EMPLOYMENT CONTRACT, BUT WILL BE MERELY A GRATUITOUS STATEMENT OF FACILITY POLICIES.

    I understand that the facility reserves the right to require its employees to submit to blood tests or urinalyses for alcohol or drug screens, or to allow inspection of bags (including purse or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to a urinalysis, blood test or search, when requested to do so, may result in termination of my employment.

    Compliance with this facility's Substance Abuse Policy is a condition of employment. This facility requires that every newly hired employee be free of alcohol or drug abuse. Each offer of employment is contingent upon successfully completing a urinalysis test/screen for alcohol and drugs in accordance with facility policy. Continued employment is also contingent with the facility's Alcohol and Drug Abuse Policy.

    I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY THE FACILITY, MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I, OR THE FACILITY WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE. I ALSO UNDERSTAND THAT THIS
    STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE ADMINISTRATOR OF THE FACILITY.

    Release:
    I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize the Registrar/Placement Office of all educational institutions attended to release an official copy of my transcript and, if available faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my licensure status and my licensure history.

    I have read and understand these conditions of employment.

    Digital Signature