Employment Application Form

What Position are you applying for?*

Name*

First NameLast Name

What is your social security number?*

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is the best time to contact you?*

Are you currently legally eligible to work in the United States? (proof of eligibility will be required upon off of employment)*

YesNo

Are you over 18 years of age?*

YesNo

Have you worked at EMHS before?*

YesNo

Have you ever applied at EMHS before?*

YesNo

Have you ever been convicted of a felony?*

YesNo

If yes, Please explain*

Offer of employment is conditioned upon satisfactorily completing an employment healthcare physical entrance examination, including an employment drug screen. Other requirements may be mandatory upon an offer of employment based on position hired and may include child abuse clearances, FBI Fingerprinting clearances, and immunization history.

Type a question*

Please upload your Resume here

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Please upload your Cover Letter here

Browse Files

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION RELEASE

Please Read Carefully Before Signing Your Employment Application

I hereby certify that all of the information provided by me in this application (or any other accompanying required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand and give authorization for EMHS to request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my criminal record, previous employment, and educational background. I understand that this application is not and is not intended to be a contract of employment. I understand, also, that I am required to abide by all rules and regulations of the Organization.

I understand, that, as a condition of my consideration for employment with EMHS, or as a condition of my continued employment with EMHS, EMHS may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verifications, criminal and civil history, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, and trustworthiness.

I hereby authorize and consent EMHS’ procurement of such a report. I understand that, pursuant to the Federal Fair Credit Reporting Act, EMHS will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with EMHS. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.

Date*

Date

Signature*

This application will be kept on file for consideration for 6 months. After 6 months, a new application must be completed for further consideration.

Employment Application Form

Personal Information

Education & Training

Licenses and/or Certifications

Employment history

References