Thank you for seeking employment with Mid-Valley Hospital. Please complete the online application below. Upon submission, your application will be sent to Human Resources, reviewed, and then forwarded to the hiring manager for the designated position. Incomplete applications will not be considered. You will be contacted by Human Resources only if an interview is requested by the hiring manager. If you wish to apply for a different opening at a later time, you must submit a new application for that position. Applications will remain on file for a year from submission date.

Personal Information

Position Applied For:*
First Name:*
Middle Name:
Last Name*

Mailing Address

Address Line 1*
Address Line 2
City*
State
Zip
Present Address Same as Above?
Permanent Address Line 1
Permanent Address Line 2
Permanent City
Permanent State
Permanent Zip
Phone*
E-mail:
Are you at least 18 years of age?
How did you hear about this position?
Do you have any relatives employed here?*
If Yes, list names and positions
Have you been previously employed here?*
If Yes, give dates
Have you been convicted of a felony or misdemeanor?*
If Yes, explain fully
Have you been in any way excluded from participation in federal healthcare programs?*
If Yes, explain fully

Languages

Spanish
Chinese
Russian
Other

Work Availability

Which schedules would you be willing to work?
Indicate shift(s) you will work:
Will you rotate shifts?
Will you work weekends?
Which days of the week would you be willing to work?

Education

College or Schools after High School (include any job related education or training and military service)

Institute
Location
Major, Skills or Trade
Degree/Diploma Received
Date Graduated
Institute #2
Location
Major, Skills or Trade
Degree/Diploma Received
Date Graduated
Institute #3
Location
Major, Skills or Trade
Degree/Diploma Received
Date Graduated

Work Experience

List most recent employer first. Include at least the past five (5) years, and account for any time gaps in your employment history, including military service.

Name of Employer
Address of Employer
Name of Supervisor
Phone:
-
May we contact?
Dates Employed (mo/yr)
Salary
Your last job title and description
Reason for leaving
Did you work for this employer under a different name?
Name of Employer #2
Address of Employer
Name of Supervisor
Phone:
-
May we contact?
Dates Employed (mo/yr)
Salary
Your last job title and description
Reason for leaving
Did you work for this employer under a different name?

Professional Registration/Licensure

Type of Registration
State
Number
Date of Exp.
Type of Registration
State
Number
Date of Exp.
Type of Registration
State
Number
Date of Exp.
If you do not have a required registration or license, have you applied for one?
If an examination is required, what date are you scheduled to take the examination?
If not licensed in Washington State, have you applied for reciprocity?

Attach Resumé *

Max file size 5MB

File types: .pdf, .doc, .docx, .rtf

Upload:

Authorization/Agreement

I certify that the information set forth in this Application for Employment is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application or failure to furnish all requested information shall be considered sufficient cause for my dismissal.

I understand that my employment shall be contingent upon proof of identity and verification of eligibility for employment in the United States in accordance with the Immigration Reform and Control Act of 1986. I further understand that my employment is contingent upon the checking of references furnished by me, and contingent on a negative drug and alcohol test result.

I consent to and authorize this employer and its personnel to request any information concerning my previous employment record as indicated on this Application for Employment. I hereby release all parties and persons connected with any request for information from all claims, liabilities, and damaged for whatever reason arising out of furnished such job related information.

I understand and agree that my employment and compensation may be terminated at any time without prior notice, with or without cause, at the option of the company or myself, and understand that no representative of the company, other than the Administrator, has authority to enter into any agreement contrary to the foregoing.

I understand that all company property must be returned and any indebtedness to the company must be paid on or before my last day of work. I authorize the company to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.

My typed name below shall have the full force and effect of my written signature.

I agree to the above terms and would like to submit my application for consideration.
Typed Name:*