Oneida Healthcare Online Application
Step 1 of 6:
Today's Date: July 30, 2010
1.
Last Name:
First Name:
Middle Initial:
Current Address:
Street
City
State
Zip
Permanent Address: If Different
Street
City
State
Zip
Home Phone:
Work Phone:
Email Address:
2.
Position Desired 1st Choice:
Position Desired 2nd Choice:
3.
Are you under 18 years of age?
Yes
No
4.
Do you have the legal right to accept employment in the United States?
Yes
No
(Non citizens may be required to produce I-141 or I551 Alien Registration Cards at time of employment.)
5A.
Are you willing to work?
YES
NO
Full-time
Part-time
Temporary
Holidays
Weekends
5B.
Are you willing to work any assigned shift?
Yes
No
List times not available:
5C.
Were you previously employed by Oneida Healthcare Center / Oneida City Hospital?
Yes
No
If yes, give dates of employment and department.
6.
Please read and click the agree button to accept the terms of this online application.
I affirm that the statements made on this application (including any attached papers) are true under the penalties of perjury. I authorize investigation of all matters contained in this application and agree that any misleading or false statements would be sufficient cause for disciplinary action including dismissal in the event of employment. I understand that employment is dependent on satisfactory completion of a physical examination and receipt by the Hospital of satisfactory references. I agree, if employed, to abide by all Hospital rules.
I accept these terms
I Don't accept these terms
7.
If any additional information relative to name change, use of an assumed name or nickname is necessary to enable a check on your work record, explain below:
8. Check appropriate box to the right of each question:
YES
NO
Were you ever dismissed or discharged from any employment for reasons other than lack of work or funds?
Did you ever resign form any employment rather than face dismissal?
Did you ever receive a discharge from the Armed Forces of the United States, which was other than "Honorable" or which was issued under other than honorable circumstances?
Except for minor traffic violations and adjudications as youthful offender, wayward minor or juvenile delinquent, have you ever been convicted of an offense against the law or are now under charges for any offense against the law?
Have you ever forfeited bail bond posted to guarantee your appearance in court to answer to any criminal charge?
If you answered yes to any of the questions above, give specifics below. None of the above circumstances represents an automatic bar to employment. Each case is considered and evaluated on individual merits in relation to the duties and responsibilities of the position for which you are applying.
9.
Do you have a New York State Driver's License?
Yes
No
Class:
Number:
Date of Expiration:
10.
Please list below specific skills and / or abilities you have that may be applicable to position(s) for which you are applying (i.e. certifications, keyboard skills, software familiarity, etc.)
