News & Blog

Application for Employment

  • McKenzie Health System offers equal employment opportunity to all qualified persons, without regard to race, religion,color, national origin, age, sex, height, weight, familial status, marital status, disability, or any other characteristic protected by law. Assistance will be provided to you in completing this application and/or job interview upon request.

  • Personal Information

  • Employment Desired

  • Education

  • If you are registered or certified in a profession or trade, please indicate the following:

  • Military

  • Employment History

    (List all previous employers, starting with the most recent place of employment)
  • (from - to)
  • (from - to)
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  • Professional References

    Give the name of three persons you have worked under the direction or supervision of.
  • Personal References

    Give the name of three persons not related to you, whom you have known at least three years.
  • Physical Record

  • Do not answer this question unless you have been informed about the requirements of the job for which you are applying.
  • In case of an emergency notify:

  • I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS IN APPLICATION SHALL BE GROUNDS FOR IMMEDIATE DISMISSAL.

    I AUTHORIZE MCKENZIE HEALTH SYSTEM AND ITS AGENTS TO INVESTIGATE ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE, INCLUDING RECORDS OF ANY FORMER EMPLOYERS, EDUCATIONAL INSTITUTIONS, POLICE DEPARTMENTS, CREDIT OR CONSUMER REPORTS, AND ANY OTHER REFERENCES OR SOURCES RELATED TO THIS APPLICATION.

    I AUTHORIZE ALL SUCH REFERENCES AND SOURCES TO RELEASE THIS INFORMATION WITHOUT LIABILITY FOR DAMAGE INCURRED IN PROVIDING IT, FURTHER, I RELEASE MCKENZIE HEALTH SYSTEM AND ITS AGENTS FROM LIABILITY AND DAMAGES RELATED TO OR ARISING OUT OF ANY REASONABLE BACKGROUND INVESTIGATIONS.

    I UNDERSTAND THAT AN OFFER OF EMPLOYMENT WILL BE CONTINGENT UPON MY ABILITY TO DEMONSTRATE MY LEGAL RIGHT TO REMAIN AND WORK IN THE UNITED STATES.

    I UNDERSTAND THIS APPLICATION IS CURRENT FOR ONLY 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION.

  • (signature)
  • MHS PERSONNEL ONLY 
     
    INTERVIEWED BY:            
    DATE:         

    COMMENTS:                                                                 

                                                                                                                                                                                          
    START DATE: 
    DEPARTMENT:
    JOB CLASSIFICATION: 
    PAY GRADE LEVEL: 
    STARTING WAGE:  
     EXEMPT   NON‐EXEMPT    
     REPLACEMENT    TEMPORARY    SUMMER ONLY    DEPARTMENT TRANSFER  
    HOURS PER WEEK:
    SHIFT HOURS:                     
    APPROVED FOR EMPLOYMENT (DEPARTMENT DIRECTOR/MANAGER SIGNATURE):
    DATE: 
    FINAL APPROVAL FOR EMPLOYMENT (HR ADMINISTRATOR OR DESIGNEE SIGNATURE):            
    DATE:
     
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