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Employment Application

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Personal Information
Education



Employment Status

Current Employer (or most recent employer)
 (mm/yyyy)
 (mm/yyyy)

  • $
Previous Employer 1
 (mm/yyyy)
 (mm/yyyy)

  • $
Previous Employer 2
 (mm/yyyy)
 (mm/yyyy)

  • $
Previous Employer 3
 (mm/yyyy)
 (mm/yyyy)

  • $
Employment Information

 (mm/dd/yyyy)






  • (A conviction will not will not automatically disqualify an applicant for a particular job. The type and seriousness of the crime, the frequency of violations, the applicant's age at the time of conviction, and the applicant's entire work and educational history will be considered.)

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Professional Reference 1
Spencer Hospital utilizes an online reference checking system and an applicant may be asked to re–enter reference information at a later date.
Professional Reference 2
Spencer Hospital utilizes an online reference checking system and an applicant may be asked to re–enter reference information at a later date.
Professional Reference 3
Spencer Hospital utilizes an online reference checking system and an applicant may be asked to re–enter reference information at a later date.
Resumé
  • (Please submit a single PDF or Microsoft Word file)
Affirmative Action Survey (Optional)

Spencer Hospital is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, age, disability or any other basis protected by federal, state or local law. No question on this form is intended to secure information to be used for such discrimination.

Spencer Hospital is required by federal regulations to report information as requested below. You submission of this information is completely voluntary and in no way affects the decision regarding your employment opportunity. The information you provide is strictly confidential and will be maintained separately from your application form.






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Applicant's Statement

1. I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal.

2. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information.

3. In consideration for my employment and by being considered for employment by Spencer Hospital, I agree to conform to the rules and regulations of Spencer Hospital and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or added to by Spencer Hospital at any time, at the sole option of Spencer Hospital and without any prior notice to me.

4. I further acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without cause, and with or without notice, at any time, at the option of Spencer Hospital or me.

5. I understand that no representative of Spencer Hospital has any authority to enter into any agreement for employment for any specified period of time, or assure or make some other personnel move, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or make any agreement contrary to the foregoing.

6. I understand that I am not to disclose any information regarding personal disability on this employment application or during the interview process.

7. I acknowledge that I have been advised that this application for a specific job position will remain active for no more than 90 days from the date it was made. I may update this application by calling Spencer Hospital Human Resources and keep my application active for up to one year.

Application Agreement

By checking this box and submitting this electronic application, I affirm that I have read and I agree to the conditions of the application above, and that all information I have provided in this application is correct and complete to the best of my knowledge.

  • Yes, I agree.