Application for Employment

Memorial Community Hospital & Health System - Application for Employment (Equal Opportunity Employer)
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Please let us know your name.
Please let us know your name.
Please let us know your name.
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Please let us know your email address.
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Hours per week
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A conviction record will not necessarily disqualify an applicant from employment. The circumstances of a conviction will be considered in relation to the nature of the job for which you apply.

Education/Training

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Education/Training

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Education/Training

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Professional Licenses, Registrations and/or Certifications

(e.g. RN, LPN, CNA, Radiology Tech, Respiratory Therapist, Pharmacist, Etc.)
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Professional References

List at least two persons who have knowledge of your work skills and character (i.e. managers, supervisors, or co-workers).
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Work Experience

Please give a complete record of all employment. Start with the most recent employment.
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Dates of Employment
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Work Experience

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Dates of Employment
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Work Experience

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Dates of Employment
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Work Experience

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Dates of Employment
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We greatly appreciate your interest. Only the most qualified candidates will receive a response. We are an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, national origin, age, disability, veteran status or any other similarly protected status.

PLEASE READ CAREFULLY BEFORE SIGNING

I understand that any false statements on this application or any other form that I complete shall be sufficient cause for rejection for employment or immediate discharge when discovered. I understand that if I accept a position with MCH & Health System, my employment will be governed by all applicable policies and procedures as outlined in the MCH & Health System policy and procedure system and employee handbook. In addition, I understand that these policies and procedures may change periodically, and the handbook will be updated on an as-needed basis. It is my responsibility to remain informed on any and all such changes. I hereby authorize this company to provide information regarding my employment to persons who have legitimate interest in the information. I hereby authorize release of any and all information regarding my employment to assist in determining my suitability for employment. I understand that this application is not a contract of employment. I understand that if I receive an offer of employment, it would be a conditional offer of employment, expressly subject to meeting the certain requirements of the job, which may include a post offer physical assessment, drug test and background investigation. I further understand that my employment would be at will, that is, I would reserve the right to terminate my employment when I choose, and my employer would reserve the same right.

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