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Application (*.pdf)

ONLINE APPLICATION FOR EMPLOYMENT

 

MINNIE HAMILTON HEATH CARE CENTER, INC.
Name:
Address:
City:
State:
Zip:
SSN:
Phone:
Position Applying For:
Are you 16 years of age or older?

Yes    No
How did you learn about Minnie Hamilton Health System?
Are you an American citizen? Yes    No
If no, what documentation will you provide to prove residency or permit to work?

Proof of citizenship or immigration status will be required upon employment

Have you ever been concvicted of, or pled guilty or no contest to a crime other than a minor traffic violation?

 

 

Yes    No

If yes, please submit in detail by fax or mail and include the date of final disposition of the case and the nature of the offense. This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the offenhse, seriousness and natuere of the violation, and rehabilitation will be taken into account.

Fax: 304-354-9323 or send by mail to: Shelia Gherke, MHHS, 186 Hospital Drive, Grantsville, WV  26147

EDUCATION
High School or last grade completed::
Name and Address of School:
Number of years completed:
Degree: Yes    No
College or Technical School:
Name and Address of School:
Course of Study:
Degree/Diploma:
Other Schooling or Training:
Address:
Course of Study
Number of years completed:
Degree/Diploma

Military Experience:
Branch of Service:
Dates Served:
Rank/Type of  Service:
Job-Related Training/Experience:

WORK EXPERIENCE: List positions starting with most recent:

Employer:
Phone:
Dates:
Duties:
Reason for Leaving:
Employer:
Phone:
Dates:
Duties:
Reason for Leaving:
Employer:
Phone:
Dates:
Duties:
Reason for Leaving:
Employer:
Phone:
Dates:
Duties:
Reason for Leaving:

REFERENCES (Don not include relatives)

Name:
Years Known:
Address:
Phone:
Name:
Years Known:
Address:
Phone:
Name:
Years Known:
Address:
Phone:

Minnie Hamilton Health System does not discriminate due to race, color, religion, creed, national origin, sex, age and disability, marital or veteran status in the hiring, promotion, discharge, layoff and transferring of personnel.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby release from liability all representatives of MHHS for trheir acts in connection with the request for and receipt of references, personal or work-related, as a result of my seeking employment at MHHS.

I authorize all persons, schools, employers and other organizations mentioned in the application to provide Minnie Hamilton with any and all information requested by Minnie Hamilton related to my qualifications for employment. I hereby release from any liability all individuals or organizations who, in good faith and without mailic, provide information to MHHS or its authorized representatives concerning my professional competence, character , and any other qualificetions pertinent to a decision on my behalf.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time, with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

I hereby understand and acknowledge that this application is not intended an employment contract.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I further understand that any job offer will be contingent upon satisfactory replies to background and reference checks. I further understand that employment with MHHS may be conditioned upon the results of a medical screening examination, skills testing and my ability to provide satisfactory documentation of my U.S. citizenship or authorization to work in the U.S.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at this time.

Full Legal Name:
Email Address:
Date: