FAITH COMMUNITY HOSPITAL

Application for Employment

EQUAL OPPORTUNITY EMPLOYER It is our policy to provide equal employment opportunities(EEO) to all applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws, except where a reasonable bona fide occupational qualification exists.

PERSONAL INFORMATION

EDUCATION AND TRAINING

School Name
School Name
City and State
# of Years Attended
Degree Received
List any other education, training, special skills or certifications/licenses that you possess related to the job.
List any machines, equipment or software programs on which you are qualified and experienced in operating.

EMPLOYMENT HISTORY List all work experience beginning with the present or most recent job held









BUSINESS REFERENCES List three individuals not related to you whom you have known at least one year.

NAME
OCCUPATION/ASSOCIATION
TELEPHONE

ADDITIONAL INFORMATION

Please provide any other information you think would be helpful to us in considering you for employment such as additional work experience, activities, certificates, honors received etc. (You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, natural origin or disability.)

CRIMINAL RECORD INFORMATION

During the past ten years, have you ever been convicted of, plead guilty to, or received probation, deferred adjudication, or any other type of alternative method of supervision or correction for a misdemeanor, having a penalty or imprisonment or a fine of more than $500.00 or a felony? (Answering yes is not an automatic bar to employment but will be considered in relation to specific job requirements.)

AGREEMENT

(Please read the following statement carefully)

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered my application may be rejected and, if employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.