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Employment Application

MEDICAL PARK IS A NON SMOKING FACILITY ALL POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS.
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Please let us know your name.

Please let us know your name.

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Please let us know your email address.

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Education

School #1
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School #2
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School #3
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School #4
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Employment History

Employer #1 (Start with Most Recent Employer First)
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Employer #2
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Employer #3
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References

Three Professional References
Professional Reference #1
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Professional Reference #2
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Professional Reference #3
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One Personal Reference
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Additional Information

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Acknowledgement and Authorization

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

All applicants understand they are to perform in accordance with HIPAA Privacy Compliance and Hitech Act regulations of the U.S. Department of Health and Human Services.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Employment will be pending a complete and satisfactory Interested Persons Report obtained by the applicant within 15 days prior to hire.

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