Rural Health Network Application

Employment Application
Your Contact Information:
First Name:*
Last Name:*
Email:*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Experience, Interest, and Availability
Which Position(s) are you applying for?

Administrative Support AssistantCustomer Service Associate (CSA)Population Health Coordinator, Tioga CountySocial Determinants Project CoordinatorOther
Which Position(s) are you applying for?
Why are you interested in a position with the Rural Health Network?*
What is CURRENTLY your higheset level of EDUCATION?*
Please indicate your level of SUPERVISORY EXPERIENCE:*
This position may require local travel with your own vehicle. Do you have access to a reliable personal vehicle?*

Please indicate your level of competency and/or experience with the following SKILLS*

	No Experience	Minimal	Average	Experienced
Excel, spreadsheets, simple database
Accounts Receivable
Word Processing
Records Administration
Supervision
Powerpoint
Accounts Payable
Reception Services
Working with vulnerable populations

Please provide details regarding your daily availability and/or time limitations
Please include any other information you would like to share with us:
Document Upload
Please attach your Resume here*

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Please attach your Cover Letter/ Letter of Interest

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Professional References: Please attach a list of 3 or more references. Optional at point of application, however finalists will be required to submit references. Reference information should include the following contact information: Name, Title, Organization, email, phone

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Please attach a brief (2-3) page writing sample if you have one available.

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Please tell us how you heard about this Rural Health Network position. Check all that apply:

CraigslistEmailFacebookFriend or Relative (list name(s) in "Other" sectionIdealistIndeedInternet searchLinkedinNewspaper articleRural Health Network WebsiteTwitterOther
Rural Health Network SCNY (RHN) is an Equal Employment Opportunity employer
RHN is committed to providing an equal opportunity to all qualified individuals who are seeking employment with RHN and to all current employees. Basic to the whole idea of social mobility is non-discrimination in employment and other operations. RHN does not discriminate on the basis of race, ethnicity, national origin, religion, age, disability or illness, gender, pregnancy, sexual orientation or gender affiliation, military/veteran status, political/union affiliation, record of convictions (unless otherwise precluded by statute), or any other classification protected by federal, state or local statute, regulation or ordinance. This policy applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, transfer, leave of absence, compensation, and training. Discrimination based on any of these groups is strictly prohibited.

Electronic Signature Statement
I understand that submission of this application constitutes affixation of my electronic signature. I verify that the information on this application accurately represents my candidacy and is true to the best of my knowledge. In the event of my active candidacy in the program, I authorize the RHN staff to investigate any statement contained in this application, and to conduct necessary reference and criminal background checks to determine my qualification.
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Employment Application