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Job Application

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

Name *
Social Security Number *

Are you authorized to work in the United States *	Yes No

Are you on lay-off and subject to recall? *	Yes No

Do you have relatives employed here?	Yes No
Name and Department of Relitive

Do you have any work restrictions? *	Yes No

Do you have any restrictions on license? *	Yes No

Contact Details

Address
City
Post code
How long have you lived there?
Telephone
Cell phone

Availability and Position Desired

Education

Do you have a High School Diploma or Equivalent?	Yes No
Name of High School?

Do you have a degree?	Yes No
Where did you complete your degree?
Title of your degree

Employment History

Employment Name
Employment Address
Beginning Date
End Date
Job Title
Nature of Work
Reason for Leaving

Employment Name
Employment Address
Beginning Date
End Date
Job Title
Nature of Work
Reason for Leaving

Employment Name
Employment Address
Beginning Date
End Date
Nature of Work
Job Title
Reason for Leaving

Special Skills and Abilities

Do you type?	Yes No
Words Per Minute

Other office machines you can operate skillfully

Do you have a working knowledge of medical terminology?	Yes No
Do you have a working knowledge of sign language for the hearing impaired?	Yes No


List any foreign language sopken fluently

Write here any additional information which you feel might affect your application

Upload your Resume and Privacy Policy

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	* I understand and agree that thus employment application, by itself or together with other company documents or policy statements, does not create a contract for employment. I also understand that I may voluntarily leave or be terminated at any time for any reason. * I certify that the answers given by me to the foregoing questions and statements are true and correct. I agree that Baton Rouge Health Services Community shall not be liable in any respect if my employment is terminated because of falsity or statements, answers or omissions made by me on this questionnaire. I expressly authorize the companies, schools, or persons names to give any information regarding my employment, character, and qualifications. * Due to the large number of applicants applying. I understand that Baton Rouge Health Services Community does not guarantee an interview or a job to any applicant, even though the Employment Application was completed. I understand that if I am employed at Baton Rouge Health Services Community it is contingent upon the satisfactory completion of a physical examination and the satisfactory recommendations from former employers and references. If employed, it would be for a probationary period, that if in the judgment of the facility, I prove unsatisfactory during this period, the employment maybe terminated by the facility without notice. * I have read and understood the privacy policy.