HODGEMAN COUNTY HEALTH CENTER

  • Instructions: If there is a question which does not apply to you, mark. “N/A”. Do not leave any question unanswered. Any false, misleading, or incomplete responses may result in disqualification for hire or immediate dismissal from employment.
 

PERSONAL INFORMATION

 

Home Address

  • A conviction record will not necessarily disqualify an applicant from employment: the circumstances of the conviction will be considered in relation to the nature and duties of the job applied for
  • The law requires that you provide evidence and a sworn statement of your citizenship or work authorization if you are hired. Any offer of employment which you received is contingent upon your providing the documentation and statement which we will request from you.
 

PRIOR EMPLOYMENT

  • List your last three jobs, beginning with the most recent (you may omit dates for jobs held more than five years ago).
 

EDUCATION AND TRAINING

  • Please list technical or trade school, college, and post-graduate education, if any:
 

OTHER SKILLS

 

VETERAN STATUS

  • A less than honorable discharge will not automatically disqualify you from employment.
 

REFERENCES

 

Upload Resume

 

Verification