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Legal Notices

Job Application Form

Indiana University Health Morgan Hospital is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, national origin, age, veteran status, the presence of a non-job related medical condition or disability or any other legally protected status. APPLICATION MUST BE FILLED OUT IN ITS ENTIRETY OR APPLICATION WILL NOT BE CONSIDERED.

* denotes a required field

Identification

Current Mailing Address
Permanent Mailing Address
Yes No
Miscellaneous
Yes No
Yes No
Yes No
(conviction will not necessarily disqualify an applicant from employment) Yes No
Yes No
Advertisement
Walk-in
Employment Agency/Recruiter
Internet
Word of Mouth
Other
Yes No

Work Preferences

Full-time (40 hours a week)
Part-time (less than 40 hours/week)
Temporary (less than one year duration)
PRN
Full-time (40 hours a week)
Part-time (less than 40 hours/week)
Temporary (less than one year duration)
PRN
Day
Evening
Night
No Preference
Day
Evening
Night
No Preference
Hour Month Week Year

Education

High School
University, Business, Technical, Military, or Vocational School
Graduate School
Licenses and/or Certificates
Driver's
Chauffeur's
Professional
Technical
Other (please indicate in the next box)
(please list issuing state or agency, ID number, and expiration date for EACH license)
Special Skills

Employment

Current Employer
Full-time Part-time Summer Temporary
Previous Employer
Full-time Part-time Summer Temporary
Previous Employer
Full-time Part-time Summer Temporary

References

(name, address, phone of someone not related to you)
(name, address, phone of someone not related to you)
(name, address, phone of someone not related to you)
(name, address, phone of someone not related to you)

Application Statement

You may contact my current employer.
Please DO NOT contact my current employer.
By checking this box, I agree to all of the below terms and conditions
Fri Oct 31 02:54:40 EDT 2014

APPLICANT'S STATEMENT
I authorize Indiana University Health Morgan Hospital at the time of my application for employment or during the course of my employment, to obtain information from any source as to my education, experience, competence, or character as it relates to the position for which I may be employed unless otherwise stated. I certify that the information contained in this application is true, complete and correct. I understand that any references and former employment stated on this application will be checked and verified. I further understand that any falsification or omission of information will cause my immediate dismissal or rejection of this application. I also understand that I may required to successfully complete a drug screen and medical exam that verifies I am free of certain communicable disease as required by State regulations and capable of performing the essential functions of the job for initial and continued employment. I further understand that in the event that I am employed, such employment is "at will." Neither I nor the employer have agreed on any specific period or length of employment nor any specific pay or benefits unless otherwise set forth in a separate contract.