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Job Application

Personal

Name(Required)
Address
Are you either a U.S. Citizen or permitted under your present visa or immigration status to work in this country?(Required)
NOTE: Proof of identity and ability to lawfully work in this country is required prior to or immediately upon employment.
Are you at least 18 years of age?(Required)
Are you able to perform essential functions of the job for which you are applying with or without a reasonable accommodations?(Required)
Please review job description before answering this question.
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Will you accept another position?
Can you work overtime?
Can you work weekends?
Applying for
Were you previously employed at an SMP Health Facility?
Have you ever been convicted of a crime involving mistreatment, neglect, abuse, assault, homicide, sex offenses, domestic violence, theft, fraud, misappropriation of another person's property, conspiracy, weapons, drugs, adulteration of food, or any other crime against person or property?(Required)
Have you ever been excluded from participation in any federal or state medicare, medicaid or any other third party payor program or have such pending action?(Required)
If Yes, a letter showing reinstatement is required for further consideration for employment.

Education

Did you graduate?
Did you graduate?
Did you graduate?
Did you graduate?

Work Experience

Employer Job title Supervisor Address Phone Date Employed: From Date Employed: To Ending Wage Duties / Responsibilities Reason for Leaving May we contact this employer?Actions
           

Employment References

Do you have a friend or relative working here?

Professional Licenses, Registration, and/or Certifications

Do NOT Include Driver's License
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Accepted file types: pdf, doc, docx, txt, Max. file size: 8 MB.
Accepted file types: pdf, doc, docx, txt, Max. file size: 8 MB.

Important Notice to All Applicants

If you are selected for employment you must be prepared to verify your eligibility to work as required under the Immigration Reform and Control Act of 1986. This requirement applies to all new employees including U.S. citizens, permanent residents and non-immigrants. You will have to provide documents within 3 days of your hire date to verify your identity and eligibility to work.

An Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, veteran status, or any other characteristic protected by law. Please direct any request for reasonable accommodations needed during the application process to administrator.

Applicant's Statement

I have read and agree to the above statements(Required)
This field is for validation purposes and should be left unchanged.
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