Thank you for considering employment opportunities with Portneuf Medical Center. To enhance your understanding of the employment process at Portneuf Medical Center, please read the following information before completing and submitting your application.
Portneuf Medical Center is committed to a policy of non-discrimination and equal employment opportunity.
A specific job title and department for a currently posted position must be identified.
Desired Classification(s)
Desired Shift(s)
Weekends
How did you hear about this position?
Have you ever been convicted of a felony or a misdemeanor, or have you ever plead “no contest” to any criminal charges?
NOTE: Criminal conviction is not an absolute bar to employment, but will be considered in relation to specific job requirements.
Are you excluded from participating in any federal or state health care program?
Do you have any relatives employed by Portneuf Medical Center?
Have you ever been employed by, or are you currently employed by, Bannock Regional, Pocatello Regional, or Portneuf Medical Centers?
If yes...
Are you eligible to work in the United States?
Are you at least 18 years of age?
Please indicate your level of proficiency with each of the following:
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Access
Microsoft Outlook
Medical Terminology
Electronic Medical Records
List all relevant professional licenses, certifications, or registrations that you have:
Do you have any pending restrictions and/or suspensions on your current professional license/registration?
Have you ever been refused professional licensure, or had a license/registration suspended or revoked?
Please indicate all current certifications:
Have you graduated from High School or completed the GED equivalent?
Please list all additional education and degrees that you have received beyond High School. List your highest degree first.
Are you currently enrolled in school?
How many years do you have directly related to this position?
Have you ever been discharged from a job or asked to resign?
May we contact your current employer?
NOTE: If your current or most recent employer is not contacted before an offer of employment is made, then any offer of employment that is made will be subject to Portneuf Medical Center subsequently contacting such employer, and may be withdrawn based on the information received from such employer.
May we contact your previous employers?
Starting with your most recent employment, give a complete record of all employment and reasons for periods of unemployment for the last seven years.
Please complete all sections in full, rather than stating “see resume.” Incomplete applications will not be considered.
Please list at least three additional Professional References. (Please do not list relatives.)
I certify that the information I provided in this application and any attached resumes or cover letters is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of facts in this application or accompanying documents disqualifies me from further consideration, or, if I am employed, is sufficient cause for immediate termination, regardless of when the information is discovered.
I authorize investigation of all statements contained in this application and understand that I may be required to provide verifications (diploma, license, transcripts, type tests, etc.) of information contained in this application.
I authorize any and all persons, companies, or agencies to release to Portneuf Medical Center any and all information they may have which is relevant to the application process. I also release all such parties from any liability that may result from furnishing information to Portneuf Medical Center.
I understand that to be considered as a formal applicant, the position for which I am applying must be specifically identified as open, and recruitment for the position going on at the time this application is received by the Human Resources Department.
I understand that if I am employed with Portneuf Medical Center, my employment will be at-will. As such it can be terminated by me or by Portneuf Medical Center with or without advance notice, at any time, and for any reason not prohibited by law. If I am employed by Portneuf Medical Center, I agree to abide by the policies and rules of my employer that exist currently or that may be changed or developed in the future, and further realize it is my responsibility to review and understand the information contained in the policies and Employee Handbook and to follow the policies described therein. I acknowledge that if I fail to follow such policies, that my employment can be terminated at any time.
I understand that any employment offer is contingent upon the following: (1) producing documents establishing my eligibility to work in the United States; (2) satisfactorily passing the pre-employment drug screen, employee health evaluation, criminal background and reference checks; and (3) complying with Portneuf Medical Center’s pre-employment application procedures.
By typing my name and submitting this application to Portneuf Medical Center, I acknowledge that I have read the certification and agreement and agree to abide by its terms.
Date: 6/19/2013
