Employment Application - Rainy Lake Medical Center | International Falls

Application Date*

General Information

Full Name*

Name as it should appear on a resume

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Other Phone

Email*

Are you legally entitled to work in the United States?*

yes
no

Position

Position or Type of Employment Desired*

Are you able to perform the essential functions of the job you are applying for, with, or without reasonable accommodations?*

Yes
No

Will Accept:*

Full-time
Part-time
Casual/Temporary

Shift:*

Salary Desired*

0 of 7 max characters

Date Available for Employment*

Education

High School Graduate or General Education (GED) Test Passed?*

Yes
No

If no, list the highest grade completed

College, Business School, Military Attended

(list most recent first)

Name

Date Attended

From

To

Credits Earned (Semester Hours)

Graduate

Yes
No

Degree & Year

Major or Subject

Name

Date Attended

From

To

Credits Earned (Semester Hours)

Graduate

Yes
No

Degree & Year

Major or Subject

Name

Date Attended

From

To

Credits Earned (Semester Hours)

Graduate

Yes
No

Degree & Year

Major or Subject

Name

Date Attended

From

To

Credits Earned (Semester Hours)

Graduate

Yes
No

Degree & Year

Major or Subject

Occupational License, Certificate or Registration

Occupational License, Certificate or Registration 1

Number

Where Issued

Expiration Entry

Occupational License, Certificate or Registration 2

Number

Where Issued

Expiration Entry

Occupational License, Certificate or Registration 3

Number

Where Issued

Expiration Entry

Veteran Information

(Most recent)

Branch of Service

Date of Entry

Date of Discharge

Special Skills

List all pertinent skills and equipment that you can operate

List languages read, write or spoken fluently other than English

Previous Employment

Begin with the most recent employer first and include voluntary work and/or military service

Employer*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Employed

From

To

Are you currently employed here?

Yes
No

Job Title*

Hours Per Week

Last Salary*

Supervisor

Specific Duties

Reason For Leaving?*

May We Contact This Employer?*

Yes
No

Employer

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Employed

From

To

Are you currently employed here?

Yes
No

Job Title

Hours Per Week

Last Salary

Supervisor

Specific Duties

Reason For Leaving?

May We Contact This Employer?

Yes
No

Employer

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Employed

From

To

Are you currently employed here?

Yes
No

Job Title

Hours Per Week

Last Salary

Supervisor

Specific Duties

Reason For Leaving?

May We Contact This Employer?

Yes
No

Professional References

Candidates that are selected for the interview process will be requested to provide Reference Information at the time of interview.

Resume/Cover Letter

Drop files here or

An Equal Opportunity Employer

Rainy Lake Medical Center is an equal opportunity employer. It is policy that all individuals are entitled to equal employment opportunity regardless of race, color, religion, gender, national origin, age or disability, as required by state and federal law. RLMC is committed to this policy. All appropriate steps are taken to ensure equal opportunity in employment with respect to all personnel actions, including, but not limited to: recruiting, hiring, compensation, benefits, education and promotion/advancement opportunities. Rainy Lake Medical Center is committed to providing a drug-free, healthful and safe workplace. All prospective employees will be asked to submit to a Non-DOT DRUG SCREENING once a conditional offer of employment has been extended and accepted. An offer of employment by Rainy Lake Medical Center is contingent on the prospective employee testing negative for illegal substances.

DISCLAIMER

I certify that the information I have provided on the employment application is true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given on this application or subsequent interview(s) may result in termination of employment. I grant permission to Rainy Lake Medical Center to contact any of the employees, supervisors, managers, educational institutions, and/or references listed in this application unless I have indicated to the contrary in the appropriate fields on this application. I authorize my former and/or current employer(s) to release information pertaining to my work record, work habits, and my work performance while in their employment. I understand Rainy Lake Medical Center may, and hereby authorize it to solicit information regarding my character, felony record, driving record, previous employment, and/or similar background information. I understand that no employment offer is contingent upon a background check and /or successful completion of any other condition that may be required. I understand that my employment is contingent upon proof of identity and verification of eligibility for employment in the United States, in accordance with Immigration Reform Act of 1986. I understand that any employment offered to me is terminable at any time, with or without cause and without advance notice.

Applicant's Confirmation:

Yes, I have read and understand the above, and hereby certify that the facts I have provided in my employment application are true and complete. Please submit my application.

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