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McGehee Hospital Application for Employment

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, or disability. E.O.E

___________________________________________________________________________________

Today's Date: *

Name *

First

Last

Social Security No: *

Driver’s License No: *

Email

Phone *

Business Phone

(If you can be contacted at current job)

Address *

Address Line 1

Address Line 2

City

State

Zip Code

___________________________________________________________________________________

Position Details

Position Applying For *

Pay Expected *

Have you ever applied for employment with us? *

Yes
No

Are you legally eligible for employment in the United States? *

Yes
No

Are you: *

When will you be available to begin work if a position is offered? *

Type of Employment Desired : *

Full-time
Part-time

School: Highest level of education *

College
VoTech
High School
Other

Name And Location

Course

Degree

Year Graduated

Membership in professional or civic organizations (exclude those, which may disclose your race, color, religion, or national origin):

Please list other special training skills such as languages, equipment operated, typing, special medical courses, etc.

Do any of your friends or relatives work for McGehee Hospital? *

Yes
No

Name and relationship if answered yes

If the offer of a position is extended to you, you will be required to pass a drug screen for illegal substances at our expense. Should you fail this drug screen, the offer of employment will be automatically withdrawn.

___________________________________________________________________________________

Employment History

Please give accurate, complete full-time and part-time employment history. Start with the present or most recent employers.

1. Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Dates Employed

From/To

Name of Supervisor

First

Last

Pay

State job title and describe your work:

2. Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Dates Employed

From/To

Name of Supervisor

First

Last

Pay

State job title and describe your work:

3. Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Dates Employed

From/To

Name of Supervisor

First

Last

Pay

State job title and describe your work:

___________________________________________________________________________________

Please indicate those employers you do not wish us to contact and reasons why:

___________________________________________________________________________________

Military Service: Complete this section if you served in the United States Armed Forces.

Branch of service

Period of active duty:

From/To

Rank At Time Of Discharge:

Date of final discharge

Describe your duties and any special training:

___________________________________________________________________________________

The information requested is needed for a legally permissible reason including without limitation: National security consideration, a legitimate occupational qualification of business necessity, the Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex, or national origin. Federal law also prohibits discrimination on the basis of age with respect to certain individuals. Federal law as well as the laws of most states also prohibits some or all of the above types of discrimination as well as some additional types such as discrimination based on ancestry, marital status, or physical or mental handicap or disability.

Height *

Weight *

In (lbs.)

Gender *

Male
Female

Marital Status *

Are you allergic to any food or medications? *

Yes
No

If yes, what?

Have you been treated or tested for latex allergies or sensitivities? *

Yes
No

If yes, explain:

Are you a United States citizen? *

Yes
No

Please be able to provide us with proof of your legal right to employment in the country such as birth certificate, naturalization papers, immigration service permit or green card

What was your previous address? *

Address Line 1

Address Line 2

City

State

Zip Code

How long were you at your previous address? *

From/To

How long have you been at your current address? *

From/To

Have you ever been bonded? *

Yes
No

If yes, with which employer?

Have you ever been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which have not been annulled, expunged, or sealed by a court? *

Yes
No

Answering "YES" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account. *

If yes, please describe in full:

Cover Letter, Resume, & References

Click or drag files to this area to upload. You can upload up to 3 files.

___________________________________________________________________________________

I hereby declare the information provided by me in this application for employment is true, correct and complete to the best of my knowledge. I understand that, if employed, any misstatement or omission of act on this application shall be considered cause for dismissal. I authorize McGehee Hospital/Southeast Arkansas Home Health to obtain an investigative consumer report containing information through personal interviews with my neighbors, friends, and acquaintances. This report, if obtained, may include information as to my character, general reputation, personal characteristics and mode of living. I understand I have the right to make a written request within a reasonable period to receive additional detailed information about the nature and scope of any such investigation. I am qualified, with reasonable accommodation, to perform the specific and essential tasks of the position as outlined in the job description for this position.

Applicant Signature *

Employment Application

McGehee Hospital Application for Employment

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, or disability. E.O.E

___________________________________________________________________________________

___________________________________________________________________________________

Position Details

If the offer of a position is extended to you, you will be required to pass a drug screen for illegal substances at our expense. Should you fail this drug screen, the offer of employment will be automatically withdrawn.

___________________________________________________________________________________

Employment History

___________________________________________________________________________________

___________________________________________________________________________________

Military Service: Complete this section if you served in the United States Armed Forces.

___________________________________________________________________________________

___________________________________________________________________________________

Location

Phone

Website made possible by support from:

McGehee Hospital
900 South Third St.
McGehee, Arkansas 71654

Employment Application

McGehee Hospital Application for Employment

Prospective employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, or disability. E.O.E

___________________________________________________________________________________

___________________________________________________________________________________

Position Details

If the offer of a position is extended to you, you will be required to pass a drug screen for illegal substances at our expense. Should you fail this drug screen, the offer of employment will be automatically withdrawn.

___________________________________________________________________________________

Employment History

___________________________________________________________________________________

___________________________________________________________________________________

Military Service: Complete this section if you served in the United States Armed Forces.

___________________________________________________________________________________

___________________________________________________________________________________

Location

Phone

Website made possible by support from:

McGehee Hospital 900 South Third St. McGehee, Arkansas 71654

McGehee Hospital
900 South Third St.
McGehee, Arkansas 71654