First name*

Last name*

Email address*

Location

Phone number*

Resume*

Are you either a U.S. Citizen or permitted under your present visa or immigration status to work in this country?

NOTE: Proof of identity and ability to lawfully work in this country is required prior to or immediately upon employment.*

Are you at least 18 years of age?*

What date are you available to start?*

Which facility are you interested in?*

What type of employment are you seeking?*

Which 8-hour shift(s) are you interested in?*

What is your desired salary?*

Have you previously worked for an SMP Health facility?*

Do you currently hold any required licenses or certifications for this position?*

Are your licenses/certifications active and in good standing?*

If you hold any professional licenses, certifications, or registrations relevant to this position, please list your license/certification type, state issued, license number, and expiration date.*

Do you have a friend or relative working here? If so, please list name, relationship, and department.*

Please list a professional reference (full name and phone number) that we may call on your behalf.*

Have you ever been excluded from participation in any federal or state Medicare, Medicaid or any other third party payor program or have such pending action?

NOTE: If yes, a letter showing reinstatement is required for further consideration for employment.*

Have you ever been convicted of a crime involving mistreatment, neglect, abuse, assault, homicide, sex offenses, domestic violence, theft, fraud, misappropriation of another person's property, conspiracy, weapons, drugs, adulteration of food, or any other crime against person or property? If so, please explain.*

Applicant Certification & Consent

I certify that all information contained in this application is true, and understand that any misleading or false information or willful admission will be sufficient cause for immediate dismissal or refusal of employment.

I understand that all information in this application is subject to verification and that the facility may investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. By my signature below, I consent to a criminal history background checks. I also authorize all individuals, schools, businesses, employers (past and present), and references herein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I further understand that employment is "at-will" and that nothing contained in this employment application or statements made during the interview process if an interview is granted, are intended to create an employment contract between the facility and myself for either employment or for the providing of any benefit.

I also understand that the facility requires pre-employment drug and alcohol testing. No prospective employee will be asked to submit to testing unless an offer of employment has been made. An offer of employment is conditioned on the prospective employee testing negative for illegal drugs and alcohol. I understand and agree to submit to the required pre-employment testing if an offer of employment is made to me.

I acknowledge and understand that I am required to immediately notify the facility if any action is proposed to exclude me from participation in any federal or state Medicare, Medicaid or other third party payor program.

Incomplete information could disqualify you from consideration. Please accurately and full complete all fields/questions.*

Important Notice to All Applicants

If you are selected for employment you must be prepared to verify your eligibility to work as required under the Immigration Reform and Control Act of 1986. This requirement applies to all new employees including U.S. citizens, permanent residents and non-immigrants. You will have to provide documents within 3 days of your hire date to verify your identity and eligibility to work.*

An Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, veteran status, or any other characteristic protected by law. Please direct any request for reasonable accommodations needed during the application process to administrator.*

Human Check*