Career Opportunities


Secure Application for Employment

It is the policy of this facility to provide equal opportunity to persons regardless of race, religion
age, gender, disability or any other classification in accordance with federal, state and local
statutes, regulations and ordinances.
http://www.stantoncountyhospital.com/ Date   This Application can be active as long as legally required.
Last Name * First Name * Middle Initial
   
Are You At Least 18 Years
Old?
Social Security Number
without dashes or spaces
(secure)
Primary And Secondary Phone *
 

 
Present Address *
 
Present City *
 
Present State *
 
Present Zip Code *
 
E-Mail Address
Previous Address
Previous City
Previous State
Previous Zip Code
Current Open Position for Which You Are Applying for
Food Service Worker
Are you currently credentialed for the position for which you are applying?  
Type of Position
Shift
 
Salary Requirement
$
Are You Willing To
Travel?
Are You Willing To
Relocate?
Do you have adequate means of transportation to get to work on time each day and when called in
on short notice during normal working hours?
 
If overtime work is required periodically, does this pose a problem for you?
 
Date Available For Work
Are You Legally Authorized to Work in the U.S.? 
Have you ever worked for
Stanton County Hospital?
 
If yes, what year did you leave?
 
Are you related to another facility employee?
 
How did you learn about this position?


  
  
  
Are you able to perform the essential, job related functions of the position for which you are applying
with or without reasonable accommodations?    
Describe any accommodations necessary:  
Have you been convicted of a crime and/or released from confinement following a conviction for any
criminal offense?    

Arrests or charges that have been expunged need not be disclosed.
If yes, Give date, place and nature of each such conviction.

Are you presently charged with any violation of the law?
 
If yes, give date, place and nature of each such conviction:


Are you currently excluded from participation in any federally funded healthcare program -

including Medicare and Medicaid - and are you aware of any potential exclusion from a federally

funded health program?
 
Educational History
Type of School Name of School
City, State
Check Last Year Attended in School Degree or Certificate
High School
School:  
City:  
State:  
Graduated/GED? 
 
College
School:
City:
State:
Graduated? 
Degree: *  
Date Graduated: *  
College
School:
City:
State:
Graduated? 
Degree: *  
Date Graduated: *  
Graduate
School
School:
City:
State:
Graduated? 
Degree: *  
Date Graduated: *  
List any professional licenses, registration or certification you possess
(Include Driver's License, if applicable)
Include Type, State Issued, Expiration Date and Number.
Indicate if any licenses have been revoked, suspended or placed on probation.
Also indicate if you are ineligible to become licensed or certified in your field. Please explain.
Clerical or other skills applicable to the position for which you are applying

(WPM)



 


List Basic Computer Skills