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Application for Employment

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Address*
Are you 18 years or older?
Are you lawfully authorized to work in the U.S.?*
Have You Ever Been Convicted of a Crime Other Than A Simple Misdemeanor?*
Have you ever used another name?*
Have you ever worked at AMMC, Chateau on the Ridge, or AMMC Physician Services before?*
Are you related to any AMMC employees?*
Can you work full-time?*
Can you work part-time?*
Can you work PRN?*
What days are you available to work? Checkboxes:*
What shifts can you work? Checkboxes:*
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If hired, can you furnish proof that you are eligible to work in the U.S.?*

Educational History

Name of School
Name of School
Name of School
Name of School
Name of School
Name of School

List any professional licenses, registration or certification you possess (include Drivers License, if applicable):

Employment History

Current or Previous experience?
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1st Previous Position

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2nd Previous Position

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3rd Previous Position

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Professional References (Other than Relatives or former Employers)

Give three references who have good knowledge of your work.
Have you been fired from a job or asked to resign?*
Max. file size: 5 GB.
AMMC is committed to Zero Harm for all. We hold each other accountable with a “see something, say something” ethic; improving processes, not blaming people. Should you be hired at AMMC, our expectation is that you will also commit to Zero Harm and our statement above.

By entering my full name I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize and agree to cooperate in a thorough investigation of all statements made herein and other matters related to my background and qualifications. I understand that any investigation conducted may include a request for employment and educational history, credit reports, consumer reports, investigative consumer reports, driving record, and criminal history. I authorize any person, school, current and former employer, consumer reporting agency, and any other organization or agency to provide information relevant to such investigation and I hereby release all persons and corporations requesting or supplying information pursuant to such investigation from all liability or responsbility to me for doing so, I understand that I have the right to make a written request within a reasonable period of time for complete disclosure of the nature and scope of any investigation. I understand I am required to successfully pass a drug-screening examination. I hereby consent to a pre-and/or post-employment drug screen as a condition of being hired or of my continued employment, if required. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
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