*Required.

It is the policy of Trinity Hospital Twin City to provide equal opportunity with regard to all terms and conditions of employment. The Hospital complies with federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age, or any other protected characteristic.

Last Name:  First Name:  Middle Intial: 

Contact Number:  Email Address: 

Address:  City:  State:  Zip: 

Position applied for:  Department: 

Other position applied for:  Department: 

Shift Preference: : : 

Would you accept: 

Minimum Acceptable Starting Wage: 

On what date would you be available to start work?: 

Have you ever held previous employment here: 

If yes, please provide dates of employment and reason for leaving: 

High School

Name of School:  Location

Course of Study:  Degree/Diploma:  Yrs Completed

 

College

Name of School:  Location

Course of Study:  Degree/Diploma:  Yrs Completed

 

Graduate School

Name of School:  Location

Course of Study:  Degree/Diploma:  Yrs Completed

 

Vocational Training

Name of School:  Location

Course of Study:  Degree/Diploma:  Yrs Completed

Employment Experience

1.) Employer: 

Address:  Phone: 

Position:  Contact Person: 

Dates Employed from(mm/yy) to(mm/yy)

Reason for leaving: 


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Please explain any gaps in your employment, other than those due to personal illness, injury or disability

Special training or skills: Languages, or other special training or skills that would be of benefit in the position for which you are applying

Are you legally eligible for employment in the United States?If yes, proof may be required if hired.

Have you ever been convicted of a crime?*If yes, please explain:

A record of criminal conviction will not necessarily be a bar to employment, since the hospital will consider factors such as age, time of the offense, the nature and seriousness of the violation, and the evidence of rehabilitation in making any employment decision.

Certifications

* I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omission, or misrepresentations are discovered, my application will be rejected, and if I am employed this will be cause for immediate dismissal. I authorize the companies, schools listed above, or any agency or person having knowledge of, to give any information regarding my employment, character, general reputation, personal characteristics, education, work history or police record, to Trinity Hospital Twin City, or any of its affiliates.

I understand that my employment is contingent on passing all aspects of a pre-employment physical examination, drug and alcohol screening and criminal background check. In consideration of my employment, I agree to abide by all rules and policies of Trinity Hospital Twin City. I also understand that my employment and compensation can be terminated at any time at the option of either Trinity Hospital Twin City, or its affiliates, or myself, and that this application does not constitute an employment contract.

This application is current only for 6 months at the conclusion of which time, if you have not been contacted by Trinity Hospital Twin City and still wish to be considered for employment, it will be necessary for you to complete a new application. Please visit our website at www.twincityhospital.org to view all current position postings that are available and download an application.

Thank You