Job Application

Job Application for Mountain Hope Good Shepherd Clinic

Please complete the form below to apply for a position with us.
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
What position are you applying for?
How did you hear about this position?
Are you 18 years of age or older?

YesNo
Have you ever applied here before?

YesNo
Available Start Date

MonthDayYear
Date
Employment History
Are you currently employed?

YesNo
If yes, can we contact your present employer?

YesNo
Please complete the following information on your employment history:
Position 1

Dates of Employment
From:
To:
Name of Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Phone
Please enter a valid phone number.
Position 2

Dates of Employment
From:
To:
Name of Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Phone
Please enter a valid phone number.
Position 3

Dates of Employment
From:
From:
Name of Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Phone
Please enter a valid phone number.
Education and Qualifications
High School
Name of High School
Address of High School

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Did you graduate?

YesNo
Undergraduate College/University
Name of College/University
Address of College/University

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Did you graduate?

YesNo
Graduate Professional
Name of Graduate/Professional School
Address of Graduate/Professional School

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Did you graduate?

YesNo
Other
Name of Other Education
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Completed
Did you graduate?

YesNo
Current Certificates and Licenses
Certificate
Year Received
Expiration Date

MonthDayYear
Date
Certificate
Year Received
Expiration Date

MonthDayYear
Date
License
Year Received
Expiration Date

MonthDayYear
Date
License
Year Received
Expiration Date

MonthDayYear
Date
Professional References

Please provide three professional references
1. Company
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Title
2. Company
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Title
3. Company
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Title
Personal References

Please provide two professional references
1. Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
2. Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
The mission of Mountain Hope Good Shepherd Clinic follows: "Mountain Hope Good Shepherd Clinic is a Faith-based Community Clinic which provides quality healhcare for the medically uninsured who live or work in Sevier County." Our core vales are guided by the teachings of Jesus Christ as we value all human life, compassionate and professional healthcare, community partnerships and financial integrity. No one is turned away due to lack of money.

Please provide your thoughts on what this mission statement and core vales mean to you, thank you.
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Job Application for Mountain Hope Good Shepherd Clinic

Employment History

Please complete the following information on your employment history:

Position 1

Position 2

Position 3

Education and Qualifications

High School

Undergraduate College/University

Graduate Professional

Other

Current Certificates and Licenses

Professional References

Personal References