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ETMC Employment Application

Resume Upload
UPLOAD RESUME (Optional) You may upload a computer prepared resume that is saved on your machine. Click the Browse button to select the filename of your resume. You may upload your resume in plain text format (TXT), Microsoft Word (DOC), or Rich Text Format (RTF).

Resume Filename:

NOTE: Please be patient when including a resume. Give ample time to upload your file.

 
Tobacco/Nicotine Usage
Effective April 1, 2011 East Texas Medical Center Regional Healthcare System and it's affiliates will no longer hire applicants who use any form of tobacco/nicotine products. In addition to doing pre-employment drug screening a tobacco/nicotine test will also be done. If an applicant tests positive for tobacco/nicotine or prohibited drugs all employment offers will be revoked. In such cases the applicant may re-apply in six (6) months.
Do you currently use tobacco/nicotine? Yes No
 
Identification
First Name:
 
Last Name:
 
Middle Name:
 
SSN:
 
Present Address: Street & Number
 
City:
 
State:
Zip:
 
Telephone:
 
U.S. Citizen?
 Yes  No
Type Visa:
 
Visa #:
 
In case of emergency please notify:
 
Address:
 
Phone:
 
Do you have relatives working at East Texas Medical Center?
 Yes  No
Name:
 
Relationship:
 
Email Address:
 
Mobile Phone:
 
 
Job Status
Position or type of work applying for:
1. 

2. 
Seeking:
 Full Time  Part Time
 Temporary  
Shift willing to work:
 Day  Night
 Evening  Rotating
Available to work weekends?

 Yes  No
Salary required
 
Currently Employed?

 Yes  No
Can we contact your present employer?

 Yes  No
Presently or previously employed by:
East Texas Medical Center?
 Yes  No
Date available for work:

 
 
U.S. Military
Branch of U.S. Service:
 
Date Enlisted:
 
Date Discharged:
 
Rank at discharge:
 
Nature of duties and special training received
 
 
Training
Please indicate any educational, vocational, on-the-job, or any other training you have received which will aid us in placing you in the position that best meets your qualifications and/or in determining your qualifications for a position for which you desire to be considered.
High School:          Name & Location:
 
Degree and/or training received:
 
Major / Minor:
 
College Training:
 

 

 
Graduate School:
 

 

 
Other schools or special training (include languages and other skills)
 
Typing Speed:
  WPM
Shorthand Speed:
  WPM
Office machines or other special equipment used:
 
Professional Licenses/Certificates:
 
State Issued:
 
Number:
 
Date Received:
 
Expiration Date:
 
 
General
Have you ever been convicted or admitted guilt of a misdemeanor or felony?  Yes  No
Explain: (Conviction will not necessarily bar employment)
 
Work Experience

Start with your present or last position and work back accounting for all periods of employment.
 
PRESENT / LAST EMPLOYER
Name of Employer:
 
Type of business:
 
Address:
 
Started MM/YY:
 
Left MM/YY:
 
Starting Pay:
 
Final Pay:
 
Name & Title of supervisor:
 
Telephone:
 
Job title & description of duties and responsibilities:
 
Reason for leaving:
 

PREVIOUS EMPLOYER
Name of employer:
 
Type of business:
 
Address:
 
Started MM/YY:
 
Left MM/YY:
 
Starting Pay:
 
Final Pay:
 
Name & Title of supervisor:
 
Telephone:
 
Job title & description of duties and responsibilities:
 
Reason for leaving:
 

PREVIOUS EMPLOYER
Name of employer:
 
Type of business:
 
Address:
 
Started MM/YY:
 
Left MM/YY:
 /
Starting Pay:
 
Final Pay:
 
Name & Title of supervisor:
 
Telephone:
 
Job title & description of duties and responsibilities:
 
Reason for leaving:
 

PREVIOUS EMPLOYER
Name of employer:
 
Type of business:
 
Address:
 
Started MM/YY:
 
Left MM/YY:
 
Starting Pay:
 
Final Pay:
 
Name & Title of supervisor:
 
Telephone:
 
Job title & description of duties and responsibilities:
 
Reason for leaving:
 
 
HOW DID YOU HEAR ABOUT US?
 
AFFIDAVIT
  I certify that the information given by me in this application is correct and without consequential omissions and understand that any misstatement or omission will void this application and is grounds for dismissal in accordance with East Texas Medical Center policy. I authorize any company, school, or other institution or person to release any information regarding my employment, character, qualifications or health and release all parties from all liability for any damage that may result from furnishing same to you. In consideration of my employment, I agree to conform to the rules and regulations of East Texas Medical Center, and my employment and compensation can be terminated with or without cause, and with or without notice, at any time at the option of either the Company or myself. I understand that an offer of employment and acceptance thereof does not guarantee a specific number of hours and that time worked may be adjusted upward or downward depending upon the needs of the Company. I further understand that no manager or representative of East Texas Medical Center, other than the Administrator, has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing. I hereby additionally authorize East Texas Medical Center to withhold from my terminal pay an amount equal to the cost of replacing all Company property or uniforms issued but not returned or equal to any outstanding balance for services rendered. I understand that in order to be selected for employment, I must agree to submit to a pre-employment physical exam and test. These shall include, but are not limited to, a physical exam, x-ray, tuberculosis skin test, urinalysis, and blood test to determine the presence of contagious diseases, chemical dependency, etc. I further understand that the results of the exam and tests shall be submitted to the employer for evaluation and must satisfy the standards set by the employer before I can be considered for employment.