text It is the policy of the company to provide equal opportunity with regard to all terms and conditions of employment. The company 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. text
 
WICKENBURG COMMUNITY HOSPITAL IS A DRUG FREE / TOBACCO-FREE CAMPUS.

INCOMPLETE APPLICATIONS WILL DELAY CONSIDERATION

Wickenburg Community Hospital PARTICIPATES IN E-VERIFY

  

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Name:
 
 

Phone:

-
 
 

Address:
 
 

City:

 
 

State:
 
 

Zip:

 

     
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Position Applied For:

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Shift Preferred: 1 Space 2 Space 3 Space Any

  
 


Special Training or Skills (languages, machine operation, etc) that would benefit you in the job for which you are applying:

 
     
 

Would you accept full-time work? SpacerYes Sp No

 
     
 

On what date would you be available for work?

 
     
 

Have you ever been employed here before?spacerYes Sp No

 
     
 

If Yes, Dates Employed: to

 
     
 


Do you have a legal right to be employed in the U.S.? Spa Yes (If yes, proof is required) Sp No

 
     
 

Are you of legal age to work? Spa Yes (If yes, proof is required) Sp No

 
     

EDUCATIONAL BACKGROUND
 
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Grammar School (Name and Location):

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Course of Study:

 
 
 

Did you graduate?

Yes Sp No

 
 
 

Degree or Diploma:

  
       
       
 

High School (Name and Location):

  
 
 

Course of Study:

 
 
 

Did you graduate?

Yes Sp No

 
 
 

Degree or Diploma:

  
       
       
 

College (Name and Location):

  
 
 

Course of Study:

  
 
 

Did you graduate?

Yes Sp No

 
 
 

Degree or Diploma:

  
       
       
 

Grad School (Name and Location):

  
       
 

Course of Study:

  
       
 

Did you graduate?

Yes Sp No

 
       
 

Degree or Diploma:

  
       
       
 

Vocational, or other training (Name and Location):

  
       
 

Course of Study:

 
       
 

Did you graduate?

Yes Sp No

 
       
 

Degree or Diploma:

  
       
 

Continuing Education:

  
       

PREVIOUS EMPLOYERS AND ADDRESSES
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Place a check in the box by the employer(s) you do not want us to contact. List most recent employer first.

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Employer #1

  
     
 

Company Name:

  
       
 

Phone:

  
       

Contact Name:

  
       
 

Address:

 
       
 

Employed From:

  
       
 

Position:

 
       
 

Reason For Leaving:

 
       
 

Last Wage:

 
       
 

Employer #2

  
       
 

Company Name:

 
       
 

Phone:

 
       

Contact Name:

 
       
 

Address:

 
       
 

Employed From:

 
       
 

Position:

 
       
 

Reason For Leaving:

 
       
 

Last Wage:

 
       
 

Employer #3

  
       
 

Company Name:

 
       
 

Phone:

 
       

Contact Name:

 
       
 

Address:

 
       
 

Employed From:

 
       
 

Position:

 
       
 

Reason For Leaving:

  
       
 

Last Wage:

 
       
 

Employer #4

  
       
 

Company Name:

 
       
 

Phone:

 
       

Contact Name:

 
       
 

Address:

 
       
 

Employed From:

 
       
 

Position:

 
       
 

Reason For Leaving:

  
       
 

Last Wage:

 
       
 
       
 

I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omission, or misrepresentations are discovered, my application may be affected, and if employed, my employment, may be terminated at any time.

I agree to conform to the company’s rules and regulations, and I understand my employment can be terminated, with or without cause, with or without notice. I also understand that the terms and conditions of my employment may be changed, with or without cause, and with or without notice.

  
       
 

Type Your Name:

(this will act as your signature)