Important Information to Know Before Filling Out an Application for Employment with Mineral Community Hospital

1. All areas of the application must be filled out completely and accurately. Please fill in all the required information directly on the application and do not indicate “see resume”. Please also attach your resume if you have one towards the end of this form.

2. If you are offered a position with Mineral Community Hospital, be aware that we may verify all of the information that you have written on the application, as well as your resume. If there is a discrepancy in your information, the job offer may be withdrawn. It is important to be sure that what you have written is correct.

3. If you have any questions about completing the application, it is important to please ask the Human Resource Director.

Thank you for your cooperation.

Applicant Acknowledgement

My signature below indicates that I have read and understand the importance of supplying accurate information on the application. I am also aware of the possibility of an offer of employment being withdrawn if any of the information is not correct.

  • Level & Type of Education

  • Special Skills

  • Employment Record

    Please list your most recent jobs first. Include military service as part of your employment record. If you have a resume, please attach it to this form located just above form submission button.
  • Employment Record Cont.

  • Employment Record Cont.

  • General Information

    (Conviction of a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time that has passed since the conviction and/or completion on any sentence, and the nature of the job for which you have applied will be considered)
  • Additional Information:

    Please use the space provided to list any additional employers, periods of time not worked, or any other information that you believe we should know in considering your application for employment.
  • Additional References:

  • Please read carefully, initial each paragraph and sign below:

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