SEQUOYAH MEMORIAL HOSPITAL ONLINE JOB APPLICATION

All applicants will be considered for employment without regard to race, religion, color, sex, national origin, age, marital or veteran status, medical condition, handicap or disability, sexual orientation, citizenship status or any other status protected by law. We are an Equal Opportunity Employer.

Personal Information

Last Name:
First Name:
Middle:
Permanent Address Street:
City:
State:
Zip Code:
Phone No.:
Referred By:
Are you of legal age to work?	Yes No
Are you legally eligible for empoyment in the United States?	Yes No
Your Email:

Employment Desired

Position:
Date you can start:
Salary Desired:
Have you worked for us before?	Yes No
Date you applied to this company:
Position you held before in this company:

Education

Name and Location	Graduated	Subject Studied
High School:	Yes No

College:	Yes No

Other:	Yes No

Are you employed now?	Yes No
Will you work overtime if required?	Yes No
Have you ever been bonded in prior employment?	Yes No
Have you been convicted of a felony?	Yes No

Former Employers

List below last three employers starting with last one first:
From Date:	To Date:

Employer Name and Address:
Salary:
Position:
Reason for Leaving:

From Date:	To Date:

Employer Name and Address:
Salary:
Position:
Reason for Leaving:

From Date:	To Date:

Employer Name and Address:
Salary:
Position:
Reason for Leaving:

Military Service

From Date:	To Date:

Branch of Service:
Rank & Duties:
Date Discharged:

References

Give below the names of three persons not related to you whom you have known at least on year.
Name:
Address:
Business:
Phone:
Years Aquainted:

Name:
Address:
Business:
Phone:
Years Aquainted:

Name:
Address:
Business:
Phone:
Years Aquainted:

The above information is true and complete to the best of my knowledge. Should I be employed by the Company, any misrepresentation or false statement contained herein may be considered cause for possible dismissal. The Company, in compliance with the provisions of the Fair Credit Reporting Act of Sept. 1997, may contact directly or employ the services of investigative agencies to obtain all necessary information from the references I have listed or any other sources, concerning my prior employment, personal history or credit standing. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Company.

I understand this application does not constitute an employment contract of any kind. Should I be employed by the Company, I may resign such employment at any time at my discretion with or without prior notice and the Company may terminate my employment at any time at their discretion, with or without cause and with or without prior notice.

I Accept

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