Job Application


Step 1 of 5 General Information

Files must be less than 5 MB.
Allowed file types: txt pdf doc docx odt.
Mailing Address

Step 2 of 5 Work History

Starting with your present position, give a complete record of all employment, include military service and time not worked, in the past ten years.
Dates Employed *
Empty 'End date' values will use the 'Start date' values.
E.g., 12/2017
E.g., 12/2017

Step 3 of 5 Education, Training, and Certification

Education and Training
Graduation Date
Format: 12/2017
Graduate Work
Graduation Date
Format: 12/2017
Graduation Date
Format: 12/2017
Professional Licensure and Certification
Original Date of Issue
Format: 12/2017
Expiration Date
Format: 12/2017

Step 4 of 5 Personal

Note: Conviction of a crime is not necessarily grounds for disqualification.
Year Left
Format: 2017
Date of Interview
Format: 12/13/2017

Step 5 of 5 Statement

If employed, I agree that I shall be bound by the rules, policies, regulations, terms and conditions of employment of Hayes Green Beach Memorial Hospital as they are from time to time changed with or without notice to me.

I understand that employment is contingent upon the satisfactory completion of a post-offer health screening including successfully passing drug and alcohol testing, verification of past employment and references, school transcripts, licensures and certifications and a satisfactory criminal background check. I hereby consent to such examinations and verifications. Applicants are required to furnish proof of identity and legal work authorization prior to hire.

I state that the answers given here are true and complete to the best of my knowledge. I understand that any misrepresentation, omissions of facts or incomplete answers in my application document will disqualify me from further consideration for employment. I further understand that if employed, any misrepresentations or admissions of facts in any application document will be cause for my dismissal at any time without prior notice. I must continue to be available to work any shift that Hayes Green Beach Memorial Hospital may need me. I acknowledge that this application will be active for six (6) months, after which time I must re-apply for further consideration. I understand that all employment at HGB is employment-at-will and may be terminated by HGB or me at any time for any reason.

Please write your full name in the given area. It will count as your digital signature.