Applicant Information

Email

Employment Information

Positions Applied For

How did you learn of this opening?

Hours desired per week.

Education

High School

Please include name, address, number of years attended, degree / diploma received and any additional relevant information

College/University

Please include name, address, number of years attended, course / major, degree received and any additional relevant information

Employment History

Present or Last Employer

Please include name, address, phone number, title & duties, date range of employment and salary / hourly wage

Reason for leaving

Second Recent Employer

Please include name, address, phone number, title & duties, date range of employment and salary / hourly wage

Reason for leaving

Other Experience

Other educational experiences or job skills that you feel would help us in determining your qualifications?

Note: If your school or employment records are under another name, please indicate that name here for reference requests:

Give names, addresses and telephone numbers of three professional/work related references excluding relatives. Nursing students: Please list instructors for a reference.

Reference 1

Association

Give names, addresses and telephone numbers of three professional/work related references excluding relatives. Nursing students: Please list instructors for a reference.

Reference 2

Association

Give names, addresses and telephone numbers of three professional/work related references excluding relatives. Nursing students: Please list instructors for a reference.

Reference 3

Association

PLEASE READ THIS CAREFULLY

I hereby authorize investigation of all statements contained in this application. I affirm that all information contained in this application is true and complete and that any misrepresentation, falsification, or willful omission could be sufficient reason for dismissal and/or refusal of employment.

Signature

Typing your name represents your digital signature.

RELEASE FOR EMPLOYMENT APPLICATION

I hereby authorize Richardton Health Center to process my application for employment by checking references with former employees, schools or colleges and individuals. I also release the individuals, companies or institutions from which Richardton Health Center may request information concerning me, from all liability for any damage whatsoever incurred in furnishing reference information.

Signature

Typing your name represents your digital signature.

What happens next?

Your application will be reviewed by the RHC administrator and/or department head. Based on this review, you may be notified by RHC to discuss your application further and/or scheduled for an employment interview. Note: RHC will conduct reference and background checks only after you have been interviewed and have accepted a tentative offer of employment. If you do not hear from us, your application will be filed for 6 months. We appreciate your interest in our organization. A clear understanding of your background, education, training and work history will aid us in determining your qualifications. Please give complete answers on all information.

Careers

at Richardton Health Center

Thank you for your interest in employment with Richardton Health Center, Inc. (RHC).

Current Openings:

FT Charge Nurse (RN or LPN)

Application for Employment

Thank you

for submitting an Application for Employment with Richardton Health Center.