Frio Regional Hospital

You are applying for the following position:

In considering your application for employment, the facility may conduct a detailed and thorough investigation which may include, but is not limited to, a criminal record check, or interviews or inquiries of prior employers, coworkers, acquaintances, relatives or friends.

Date of application:

Personal information

*Last name:

*First name:

Middle name:

*Present address:

*City:

*State:

*ZIP code:

Permanent address:

City:

State:

ZIP code:

*Any previous name(s)?

Yes No

*Social security number:

*Home telephone number:

*Contact telephone number:

Best time to contact you:

*Date available for work:

*Are you applying for:

Full time Part time Regular Temporary

*Position(s) applied for:

Salary desired:

How were you referred to this facility?

*Relatives or friends employed in this facility?

Yes No

*Have you ever been employed by this facility?

Yes No

*Are you 18 years of age or older?

Yes No

*Are you a U.S. citizen or an alien legally authorized to work in the United States?

Yes No

Would you consider working:

*Weekends & holidays:

Yes No

*Rotating shifts

Yes No

*On call

Yes No

*Any shift

Yes No

*Shift preference:

Days Evenings Nights

Long-range occupational goals:

*Have you ever been convicted of, or plead guilty to, a crime (excluding misdemeanor traffic violations)?

Yes No

*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?

Yes No

If your answer is "yes" to either of the two questions above, you will not automatically be disqualified from employment consideration, except as required by state or federal law.

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Job application

Frio Regional Hospital

Personal information