North Alabama Medical Center
ECM East
Shoals Hospital
An equal opportunity employer.
     
Application date:
05/25/2020
     
Last Name: required
First Name: required
Middle Name:
Specific Position(s) Desired: required


Facility:
[NAMC ] [Shoals ] required
Current Address (Number and Street): required
  Select:
[Full Time ] [ Part Time ] [ Temp ] [PRN ]
City: required
State: required
Zip Code: required
Willing to work weekends?
Willing to work holidays?
Willing to work shifts?
Yes
Yes
Yes
No
No
No
Telephone: required
( )
Social Security Number: required


Days
Nights
Evenings
Yes
Yes
Yes
No
No
No
  Are you at least 18 years of age? Yes No  
Referral Source:
Advertisement
Employment Agency
Walk In
Relative
Friend
Other
  Are you currently a member of a reserve unit? Yes No
Professional organizations, interests, hobbies (omit any which might indicate race, religion, color, national origin, disability, age, sex or ancestry.)
       
Name & Address of High School: required
Dates Attended: required
Graduate?
Yes No
Diploma or GED:
Name & Address of College:
Course or Major:
Dates Attended:
Graduate?
Yes No
Degree:
Name & Address of Business, Technical, or Professional School(s) Attended:

Course or Major:
Dates Attended:
Graduate?
Yes No
Degree or Diploma:
Other Special Training or Certificates:
     
List Number and Expiration Date of Any Professional or Occupational Licenses:



State:



 
List any Maintenance or Shop Equipment you operate:
List any Office Equipment
you Operate:
List Computer
Software Skills:
   
Do you type? Yes No WPM:    

Personal / Professional References:
Name:
Phone:

Name:
Phone:

In Case of Emergency Notify
Name:
Address:
Phone:

       
Begin with your most recent job. Use comments area below if necessary.    
Dates of Employment:
From:
   
To:
   
Employer's Name: required

Employer's Address: required

 

Supervisor's Name: required

Supervisor's Phone: required
Reason for Leaving:

Starting Salary:

Ending Salary:

Job Title/Duties: required

May we contact? Yes No

Full Time
Part Time
PRN

Dates of Employment:
From:
   
To:
   
Employer's Name:

Employer's Address:

 

Supervisor's Name:

Supervisor's Phone:
Reason for Leaving:

Starting Salary:

Ending Salary:

Job Title/Duties:

May we contact? Yes No

Full Time
Part Time
PRN

Dates of Employment:
From:
   
To:
   
Employer's Name:

Employer's Address:

 

Supervisor's Name:

Supervisor's Phone:
Reason for Leaving:

Starting Salary:

Ending Salary:

Job Title/Duties:

May we contact? Yes No

Full Time
Part Time
PRN

Dates of Employment:
From:
   
To:
   
Employer's Name:

Employer's Address:

 

Supervisor's Name:

Supervisor's Phone:
Reason for Leaving:

Starting Salary:

Ending Salary:

Job Title/Duties:

May we contact? Yes No

Full Time
Part Time
PRN

Have you ever worked for any of the North Alabama Medical Center facilities?
Yes No

If yes, which facility?
Dates
From:
   

To:
   
Name of Relatives Employed by any North Alabama Medical Center facility:
Relationship:
   
     
1. Have you ever been convicted of any crime other than a minor traffic violation?
Yes No  
      If yes, list offenses:
   
Date of Conviction:
 
2. Have you ever been refused a surety bond? Yes No Why?
3. Are you able to perform the functions of the job for which you have applied with or without an accommodation?  Yes No
4. Have you ever been discharged from a non-military position? Yes No  
NOTE: An answer of yes to any of the above questions does not necessarily disqualify you from employment with North Alabama Medical Center. All hiring decisions will be based on job-related factors which are consistent with business necessity.
5. Are you a citizen or otherwise authorized to work in the U.S.? Yes No  

Upload Resume (NOT required. PDF or Word format only.):

Comments/questions/additions (NOT required):

CERTIFICATE OF APPLICANT

ATTENTION: Read the following statement carefully before sending this application.

I hereby state that the information given by me in this application is true in all respects. I agree that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance while in their employ. In making application for employment, I understand that an investigative report may be made by a consumer reporting agency to include information as to my character, general reputation, personal characteristics, and mode of living, whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such a report has been requested and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.

I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will merely be a gratuitous statement of North Alabama Medical Center current policies.

I understand and agree that if I am offered employment by North Alabama Medical Center my employment will be for no definite term and that either I, or North Alabama Medical Center, will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice. I also understand that this status can be altered by a written contract of employment that is specific as to all material terms, and is signed by me and the Chief Executive Officer of North Alabama Medical Center. I also understand and agree that the duties of the position, including shift and location, may be changed without notice any time during employment.

I consent to taking a post employment physical examination/drug screen and such future physical examinations/drug screens as may be required by the organization.

 

Name:
Initials:
Date: required
 
 
Email Address: required
   
NOTE: Pressing "Send" will submit your application. Please check your information, as you will not be able to correct mistakes after sending.

 
 Only press "Send" once!