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Job Application

for Lady of the Sea General Hospital

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YOU ARE APPLYING FOR THIS POSITION:
PRN Phlebotomist in Laboratory

1OTHER POSITIONS

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2PERSONAL INFORMATION










3PROFESSIONAL INFORMATION Type of Employment: (check all that apply)




Days Available: (check all that apply)









Professional Information(if applicable):













Are you: ***
A previous employee?    
18 or over?    
A citizen of the United States?    
Legally able to work in the U.S.?    
A licensed driver with a car available for work?    

Please tell us how you became informed about this position: (choose one)  
  
  
  
Lady of the Sea website  
Family or Friends  
Other  
4EDUCATION
 ------Business or Tech------ 




 ------College or University------ 




 ------Other Training------ 




5REFERENCES  ------Employment Reference (1)------ 






 ------Employment Reference (2)------ 






 ------Employment Reference (3)------ 






 ------Employment Reference (4)------ 






 ------Personal Reference (1)------ 




 ------Personal Reference (2)------ 




6BACKGROUND

NOTICE:  A criminal background check will be performed for all candidates hired.  Therefore, your response to the following question should match the results of the background check.  Failure to disclose criminal history other than traffic violations may result in termination.


Have you ever been arrested for or convicted of or pled nolo contendere to any crime or crimes? ***
  

7NEPOTISM

NOTICE: Immediate family members of the Board of Commissioners and CEO may not be eligible to work at this facility.  Also, immediate family members of Managers may not be eligible to work in that manager's department.


Do you have a relative who is a member of the Board of Commissioners at Lady of the Sea? ***
  
Do you have a relative employed at Lady of the Sea? ***
  

8APPLICANT STATEMENT

I certify that all information given on this application is true, correct and complete.
I certify that I have accounted for all of my work experience and training.
I understand that any false information, willful or negligent misrepresentation, or failure to disclose any requested information will constitute sufficient grounds for Lady of the Sea General Hospital to cancel consideration for employment or to terminate my employment without notice.
I authorize any inquiry to be made on any information contained in this application.
I authorize any previous employers, schools, or persons named as reference to give any information regarding my employment offer is not tendered, is withdrawn or my employment is terminated of falsity of statements, answers or omissions made by me in this application.
I hereby release said employers, schools, or persons from all liability for any damages whatsoever for issuing this information.
I agree to submit to a physical examination and drug screening and understand that provided Lady of the Sea General Hospital otherwise wishes to hire me, my employment at Lady of the Sea General Hospital depends upon the results of such examination and screening being acceptable to Lady of the Sea General Hospital.
I understand that operating conditions may require me to temporarily work shifts other than the one for which I am applying and I agree to such scheduling changes as directed by my supervisor/manager.
I further understand that an offer of employment does not constitute a contract between the applicant and Lady of the Sea General Hospital.
I understand that if employed, such employment is for an indefinite period, may be terminated by Lady of the Sea General Hospital or the applicant at any time with or without cause, and is subject to change in wages, conditions, benefits, and operating policies at Lady of the Sea General Hospital.
If employment is obtained under this application, I will comply with all policies and procedures of Lady of the Sea General Hospital.
I have read the description of the position available that I am applying for and can meet the physical requirements thereof.


Lady of the Sea General Hospital does not discriminate on the basis of any protective status.

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Latest application revision: 04/2013

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