Employment Application

Name(Required)
Please check type(s) of work schedules you will accept(Required)
Do not check those you are unwilling to accept
Bilingual Language Skills (Other than English)
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Language
Speak (Yes/No)
Read (Yes/No)
Write (Yes/No)
 

Education

High School
Name & Address of Educational Institution
Major Subject
Minor Subject
Graduated? (Yes/No/GED)
College
Name & Address of Educational Institution
Major Subject
Minor Subject
Diploma/Degree & Dates Attended
 
Graduate School
Name & Address of Educational Institution
Major Subject
Minor Subject
Diploma/Degree & Dates Attended
 
Other
Name & Address of Educational Institution
Major Subject
Minor Subject
Diploma/Degree & Dates Attended
 
Special licenses, certificates or credentials
List special licenses, certificates or credentials relevant to this position.
Title
Number
Issued by
Expiration Date
 
Please list job-related organizations, clubs, professional societies, or other associations to which you belong. You may omit those which indicate your race, religious creed, color, national origin, sex, age, sexual preference, political beliefs or handicap.

Experience

Please begin with present or most recent experience; include both paid and voluntary experience. Fill out this form completely; do not mark “see resume.” Attach a resume and other supplemental material which will help in evaluating your application
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May we contact?
Work Schedule

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May we contact?
Work Schedule

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Work Schedule

Other Employment References

Other Employment References
Click the (+) symbol to the right to add more references (maximum of 4)
Employer
Supervisor's Name
Phone Number / Email
 
Upload your cover letter, resume or any other relevant documents
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Max. file size: 32 MB.

    Community Health Trust of Pajaro Valley is an equal opportunity employer. The Trust does not discriminate in employment on account of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression or transgender, age, military and veterans status or sexual orientation.

    I hereby affirm that the information provided on this Employment Application (and accompanying resume, if any) is true and complete. I also agree that any false information or significant omissions will disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize and agree to cooperate in any investigation of my past employment, education and financial history and background, and release from liability all persons or entities requesting or supplying such information.

    I understand that should I accept an offer of employment, that either the Trust or I can terminate my employment at any time for any reason, that I am not being employed for any specified duration and that this Employment Application does not constitute a contract of employment.

    I understand and acknowledge that, aside from this employment-at-will relationship, no one other than the Executive Director has the authority to enter into any other employment contract between me and the Trust, and that any such contract must be in writing and executed by me and such officer on behalf of the Trust. I understand that should I accept an offer of employment, I may be required, as a condition of employment, to execute a confidential information/non-solicitation agreement, in which event I agree to be bound by the terms of such agreement(s).

    I understand that this application applies only to the position sought at present and that Community Health Trust of Pajaro Valley is not obligated to retain or consider this application for future openings. I also understand that this application will only be considered active for 30 days.

    I understand that any offer of employment is contingent upon my producing documentation to verify my identity and my legal authorization to work in the United States, as required by federal law.

    I understand that the completion of this application does not establish any obligation upon the Trust to hire me.

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