Employment Application Logo
  • Employment Application

    Edwards County Medical Center is an Equal Opportunity Employer.  We do not unlawfully discriminate against any applicant on the basis of race, color, religion, sex, national origin, age, sexual orientation, disability or any other category protected by federal, state or local law.
  • Applicant Information

  •  / /
  •  / /
  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Education

  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • References

    Please list at least three personal or professional references — not previous employers or relatives.
  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Previous Employment

  •  / /
  •  / /
  •  / /
  •  / /
  •  / /
  •  / /
  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Military Service

  •  - -
  •  - -
  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Special Skills & Qualifications

  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Disclaimer & Signature

  • I hereby declare that the information provided by me in this Application for Employment (and in any accompanying resume) is true, correct and complete to the best of my knowledge.  I authorize Edwards County Hospital (or its designee) to investigate my past and present employment, education and activities and verify all data provided by me on this application, on related papers and in interviews.  I authorize all individuals, schools and/or firms named herein (except my current employer, if so noted) to provide any information requested about me.  I release from all liability any persons, companies, corporations or educational institutions supplying such information.  I release Edwards County Hospital (or its designee) from any and all liability resulting from the verification of such information.  I understand that any false statement or material omission on this application, or on any supporting documents, shall be grounds for non-hire or discharge, regardless of when discovered by Edwards County Hospital.


    I understand that this employment application, or the granting of an interview, does not represent a contract of employment or a promise of future benefits by Edwards County Hospital.  I further understand that there is no guarantee that Edwards County Hospital will be able to place me with one of its clients.  If I am hired by Edwards County Hospital, I understand that my status will be that of an employee-at-will, meaning that I will have no contractual right, express or implied to remain in Edwards County Hospital’s employ.  I further understand that, if I am hired, my employment can be terminated, with or without cause and with or without notice at any time, at the option of Edwards County Hospital or me.  I also understand that no representative of Edwards County Hospital has the authority to enter into any oral agreement for employment for a specified period of time or to make an oral agreement contrary to the foregoing.


    I understand that Edwards County Hospital requires a physical examination as a condition of employment.


    I understand that if I am hired by Edwards County Hospital and my employment subsequently ends, Edwards County Hospital may provide information about my employment to persons in response to job reference requests, and I hereby consent to such disclosures.


    If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Powered by Jotform SignClear
  •  / /
  • This is a secure form with content collected in a secure area built in JotForms. Upon clicking a save, or submit button, you will receive an automated email from JotForms. No additional action is necessary on your part. Please see our privacy policy for more information.

  • Should be Empty: