Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Phone Number
*
Format: (000) 000-0000.
Position Information
Position Applied For
*
How did you hear about us?
*
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LinkedIn
Event
Social Media
Company Website
Family / Friend
Other
Available Start Date
*
-
Month
-
Day
Year
Application Materials
Resume Upload
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Cover Letter (Optional)
Work Eligibility
Are you authorized to work in the United States?
*
Yes
No
Will you now or in the future require sponsorship for employment visa status?
*
Yes
No
Employment History
Employer 1 (Most Recent)
Employer 2 (Previous)
Employer 3 (Earliest)
Professional References
Please provide at least one professional reference. References may not be related to you.
Reference 1
Reference 2
Reference 3
Education
Please list the most recent education program you attended.
School Name
*
Location
*
Degree / Program
Graduation Date or Date Last Attended
-
Month
-
Day
Year
Application Certification
By signing below, I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification from consideration or termination if hired. I authorize Sedgwick County Health Center to verify any information provided and to contact previous employers and references.
*
I have read and agree to the above certification
Electronic Signature (Type Full Name)
*
Date
*
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Month
-
Day
Year
Please verify that you are human
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