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مستشفى الدكتور نور محمد خان العام
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Employment Application
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Personal Information
First Name:
Middle Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Current Address
Street:
City:
State:
Prior Address (1)
Street:
City:
State:
Prior Address (2)
Street:
City:
State:
High School
School:
City:
State:
Diploma:
No
Yes
Undergrad School
School:
City:
State:
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Grad School
School:
City:
State
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Other School
School:
City:
State:
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Employment Information
Position Applied For:
Date You Can Start:
Desired Salary ($):
Do You Prefer:
Full-Time
Part-Time
Can you work:
Weekends
Evenings
Available:
M
Tu
W
Th
F
Sa
Su
Not Available:
Please answer all of the following questions.
1.
Are you at least 18 years of age and legally eligible to work for our company in the United States?
No
Yes
2.
Have you worked for this business before?
No
Yes
If yes, please provide dates and locations.
3.
Have you received a description of the job or been made aware of the essential functions of the job for which you are applying?
No
Yes
Employer
City:
State:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Reason For Leaving:
Prior Employer (1)
City:
State:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Reason For Leaving:
Prior Employer (2)
City:
State:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Reason For Leaving:
Job-related Skills
Please answer the following questions if the position you are applying for requires driving a motor vehicle:
1.
Do you have a valid driver's license?
No
Yes
If yes, Driver's License Number:
Date of Issue:
2.
Have you been convicted of or pled guilty to any traffic-related offense within the past five years?
No
Yes
3.
Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?
No
Yes
4.
Please list all states from which you hold or held a driver's license:
Skills
Professional Designations
Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission
Signature
Type Name in Signature Box:
Today's Date: 2010-09-06 05:27:49 AST
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