Apply For A Position

Step 1 of 5

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Date Of Application

Month

Day

Year

Which location are you applying for?(Required)

Which position are you applying for?(Required)

Personal Information

First(Required)

Middle

Last(Required)

Permanent Address(Required)

City(Required)

State(Required)

Zip(Required)

Any Previous Names?(Required)

Yes

Social Security Number(Required)

Home Telephone Number(Required)

Contact Phone Number(Required)

Email(Required)

Best Contact Time For You

Date Available For Work(Required)

Are You Applying For(Required)

Full Time

Part Time

Regular

Temporary

This field is hidden when viewing the form

Position(s) Applied For

Salary Desired

How Were You Referred To this Facility?

Relative Or Friends Employed In This Facility?(Required)

Yes

Have You Ever Been Employed By This Facility(Required)

Yes

Are You 18 Years Of Age Or Older?(Required)

Yes

Are You A US Citizen Or Alien Legally Authorized To Work In The United States?(Required)

Yes

Would You Consider Working:(Required)

Weekends & Holidays

Rotating Shifts

On Call

Any Shift

Shift Preference(Required)

Days

Evenings

Nights

Long Range Occupational Goals

Have You Ever Been Convicted Of, Or Plead Guily To, A Crime (Excluding Misdemeanor Traffic Violation)?(Required)

Yes

Have You Ever Been Involved In The Substantiated Abuse Or Neglect Of Children Or Adults Under The Laws Of This Or Any Other State Of The United States?(Required)

Yes

If you answered yes to either of the two questions above, you will not automatically be disqualified from employment consideration, except as required by state law.

Education / Skills

High School Name(Required)

High School Address(Required)

High School Course Of Study(Required)

Last Year Of High School Completed(Required)

Did you Graduate High School?(Required)

Yes

List High School Diploma Or Degree(Required)

College Name(Required)

College Address(Required)

College Course Of Study(Required)

Last Year Of College Completed(Required)

Did you Graduate College?(Required)

Yes

List College Diploma Or Degree(Required)

2nd College Name

2nd College Address

2nd College Course Of Study

Last Year Of 2nd College Completed

Did you Graduate From Your 2nd College?(Required)

Yes

List 2nd College Diploma Or Degree

Other - business college or special courses (include special military training, post-graduate and nursing)

Area(s) of special interest or major interest

Typing approximate WPM

Shorthand approximate WPM

List healthcare, business or industrial equipment operated

Professional License

License Status

Currently licensed

Eligible for license

Currently registered

Eligible for registration

License or registration ever suspended, revoked or on probation?

Yes

Professional Certification

Certification Status

Currently certified

Eligible for certification

Type

State

Date

Language Skills

Do not complete unless requested.

Language

Do you?

Speak

Read

Write

Experience

Provide information regarding previous employment, beginning with most recent employer.

Job title(Required)

Dates employed(Required)

Supervisor's name(Required)

Salary (hr/mo/yr)

Employer(Required)

Employer Phone(Required)

Employer Address(Required)

Street Address City State ZIP Code

Duties(Required)

Rate Of Pay(Required)

Reason for leaving(Required)

Additional job experience

Job title

Dates employed

Supervisor's name

Salary (hr/mo/yr)

Employer

Employer Phone

Employer Address

Street Address City State ZIP Code

Duties

Rate of pay

Reason for leaving

Untitled

Please identify and explain any gaps in employment longer than three (3) months

Did you serve in the U.S. Armed Forces?

Yes

Have you volunteered your time or services?

Yes

Have you volunteered your time or services?

References

List at least three (3) references who are not relatives.

Name and relationship(Required)

Title

Phone(Required)

Company name and address

Name and relationship(Required)

Title

Phone(Required)

Company name and address

Name and relationship(Required)

Title

Phone(Required)

Company name and address

Name and relationship(Required)

Title

Phone(Required)

Company name and address

Please upload a copy of your resume

Accepted file types: pdf, doc, docx, txt, Max. file size: 512 MB.

Standards of behavior

Mission: We are committed to providing exceptional healthcare with compassion and respect.

I am willing to commit to the following standards of behavior as an employee of Frio Regional Hospital:

I will create an exceptional patient/customer experience by providing the highest quality care/service in a compassionate and respectful manner.
I will demonstrate a positive attitude and work collaboratively with my coworkers to achieve our goals as a department and facility.
I will honor the value of diversity and treat everyone with dignity and respect.
I will actively listen for needs of patients, visitors, physicians, coworkers, and customers and provide assistance whenever possible.
I will earn the trust of others by holding myself accountable to do what is right at all times.

Candidate consent agreement

In making application for employment:

I certified that the information I enter into this applicant tracking system is true and complete for all practical purposes. It may be verified by the facility or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that the facility or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate discharge without recourse.
I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of facility policies.
I understand that the facility reserves the right to require its employees to submit to blood tests or urinalyses for drug screens. I understand that refusal to submit to a urinalysis/and or blood test when requested to do so, may result in termination of my employment.
Compliance with this facility's Substance Abuse Policy is a condition of employment. This facility requires that every new employee be free of alcohol or drug abuse. Each offer of employment is contingent upon successfully completing a urinalysis test/screen for alcohol and drugs in accordance with facility policy.
Continued employment is also contingent upon compliance with the facility's Substance Abuse Policy.
I agree to immediately disclose to the Company any debarment, suspension, exclusion or other event that makes me ineligible to participate in any Federal healthcare program, or receive a government contract.

I understand and agree that if I am offered employment by the facility, my employment will be for no definite term and that the facility may terminate the

employment relationship for cause. Cause is defined as a reason for disciplinary action that is not arbitrary, capricious, or illegal, that is based on facts that the

employer reasonably believes to be true. Release: I hereby authorize any prior employers to provide such information concerning my employment with them as

may be requested, and also authorize the Registrar/Placement Office of all educational institutions attended to release an official copy of my transcript and, if

available, faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my licensure status and my licensure history.

Acknowledgement

By submitting your application, you hereby certify that the facts set forth in the above employment application are true and complete to the best of your knowledge.

I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may results in discharge even if discovered at a later time.

I understand that employment may be conditioned upon successfully passing a medical examination and that I may be required to satisfactory complete a drug screening as a condition of employment.

I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or sue of such information.

I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right.

Accept The Consent Agreement

I accept

I decline