Employment Application - Big Horn Hospital Association

First Name *

Middle Initial

Last Name *

Email *

Mission Statement

Big Horn Hospital Association provides quality services and promotes responsible choices to enhance the health of our communities.

Vision Statement

Big Horn Hospital Association will individualize the healthcare experience, embodying an organization of people working together, promoting a culture of personal accountability to improve the health and well-being of those we serve.

Values

Compassion – We treat our patients, communities and colleagues with sensitivity and empathy.
Accountability – We promote individual and organizational responsibility.
Respect – We honor the dignity of our patients, communities, and colleagues.
Empowering – We create an environment for individuals to make confident decisions and health choices.

I acknowledge I have read Big Horn Hospital Association’s Mission, Vision and Value Statements *Yes

General Information

Today's Date *

Position Appling For *

Referred By

Personal Information

Phone *

Street Address *

City *

State *

ZIP *

General Questions

Are you 18 years or older? *YesNo

On what date would you be available for work? *

Have you been employed by us before? *YesNo

If so, please give dates

Are you currently employed? *YesNo

If employed, may we contact your employer?YesNo

Can you perform the essential functions of this position, either with or without reasonable accommodations? *YesNo

Can you meet the attendance requirements of this position? *YesNo

Can you meet all the job requirements of this position? *YesNo

Are you available to work call when necessary? *YesNo

Have you ever applied for work under another name? *YesNo

If yes, what other name (s)

Do you have a current driver's license? *YesNo

Under your current name or any other name, have you ever been convicted of, pled guilty to, or pled no contest to a crime other than a minor infraction for which the entire punishment was a fine of $100 or more? *YesNo

Have you served any portion of a criminal sentence or been convicted of any offense that involved any form of violence such as assault, rape, child abuse, child molesting, extortion, blackmail, coercion or any crime with drugs? *YesNo

Have you served any portion of a criminal sentence or been convicted of any offense that involved embezzlement, fraud, stealing, robbery, extortion, blackmail or coercion? *YesNo

Have you ever had a certificate or license revoked or suspended? *YesNo

Have you ever been voluntarily terminated from any job or asked to resign from any job for reasons relating to your behavior or job performance? * *YesNo

Educational Institutions

Institution

City/State

Diploma/Degree

Major

Employment History

Employer

Job Title

Street Address

City

State

ZIP

Phone

Supervisor

Dates of Employment

Job Responsibilities

Reasons for Leaving

References

Reference

Name *

Phone *

Street Address

City

State

ZIP

Additional Documents

Email the following documents to : hr@bighornhospital.org

Resume
Education
License/Certification
Skills Checklist

Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I UNDERSTAND THAT:

I am subject to a background investigation as a condition of employment.
False, omitted, or misleading information given in my application or interview(s), or background information results may result in discharge.

This application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time or number of hours. Any verbal statements or promises about job security made by any person employed in this facility to any other employee or job applicant must be reduced to writing and signed by the CEO of Big Horn Hospital before becoming effective and binding upon either party.

Big Horn Hospital reserves the right to modify, revoke, suspend, terminate or change policies and procedures in whole or part at any time. I am required to abide by all rules and regulations of the employer. Confidential information must be kept confidential.

I HAVE READ, UNDERSTAND, AND BY MY SIGNATURE CONSENT TO THESE STATEMENTS.

Name *

Date *

Equal Opportunity

Big Horn Hospital is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, marital status, age or disability. All applicable state and federal statutes apply to Big Horn Hospital. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. Big Horn Hospital has a Tobacco Free Policy enforced in all buildings owned and operated by the facility. This application for employment will remain active for a limited time. Please ask for details. BEFORE A CANDIDATE CAN BE CONSIDERED FOR EMPLOYMENT, THE FOLLOWING REQUIREMENTS MUST BE MET. A copy of license or certification, if required, for the position for which you are applying. C.N.A.’s must provide a copy of Skills List from formal training and certification A Driver’s License, and Social Security card or Birth Certificate, military or other I.D. are required at hire. Tuberculosis testing is required of all new hires. All applicants and employees are subject to Background Investigations. THANK YOU FOR YOUR INTEREST IN EMPLOYMENT AT BIG HORN HOSPITAL.

Big Horn Hospital is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, marital status, age or disability. All applicable state and federal statutes apply to Big Horn Hospital. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

Big Horn Hospital has a Tobacco Free Policy enforced in all buildings owned and operated by the facility.

This application for employment will remain active for a limited time. Please ask for details.

BEFORE A CANDIDATE CAN BE CONSIDERED FOR EMPLOYMENT, THE FOLLOWING REQUIREMENTS MUST BE MET.

A copy of license or certification, if required, for the position for which you are applying.
C.N.A.’s must provide a copy of Skills List from formal training and certification
A Driver’s License, and Social Security card or Birth Certificate, military or other I.D. are required at hire. Tuberculosis testing is required of all new hires.

All applicants and employees are subject to Background Investigations.

THANK YOU FOR YOUR INTEREST IN EMPLOYMENT AT BIG HORN HOSPITAL.

Name *

Date *