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Home - Careers - Employment Opportunities - Online Employment Application

Online Employment Application

Employment Application

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

1 Personal

2 Employment History

3 Education

4 References

POSITION APPLIED FOR:*
Starting Salary Needed
Will you accept another position?
- Yes
- No
Please specify
Personal Information
Name
FirstLast
Social Security Number
Address
Street AddressCityStateZip Code
Phone
Email
Are you a U.S. Citizen
- Yes
- No
Visa Type and Number
Is your age under 18
- Yes
- No
Have you previously been employed at any division of OAHS?
- Yes
- No
Which Department?
When?
Have you ever been convicted of a crime?
- Yes
- No
Give date(s), Offense(s), and Disposition:
Do you have a friend or relative working here?
- Yes
- No
Name
Relationship

Employment History
Please list the most recent position first.
Name of Employer
Address
Street AddressCityStateZip Code
Phone
Name of Supervisor
Dates Employed
Position Held
Briefly describe the work you performed
Reason for leaving?
May we contact this employer?
- Yes
- No
Name of Employer
Address
Street AddressAddress Line 2CityStateZip Code
Phone
Name of Supervisor
Dates Employed
Position Held
Briefly describe the work you performed
Reason for leaving?
May we contact this employer?
- Yes
- No
Name of Employer
Address
Street AddressCityStateZip Code
Phone
Name of Supervisor
Dates Employed
Position Held
Briefly describe the work you performed
Reason for leaving?
May we contact this employer?
- Yes
- No

Education
Elementary School
Name of School Location
# of years completed Course of Study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
High School
Name of School Location
# of Years Completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
Trade
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
College
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
Additional Education
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
Name of School Location
# of years completed Course of study
Did You Graduate?
- Yes
- No
Type of Diploma/Degree
List of health care, business or industrial equipment that you operate proficiently
Language Skills
(where related to the position sought)
Language
e.g. English
Do you Speak?
- Fair
- Good
- Fluent
Do you Read?
- Fair
- Good
- Fluent
Do you Write?
- Fair
- Good
- Fluent
Language
e.g. English
Do you Speak?
- Fair
- Good
- Fluent
Do you Read?
- Fair
- Good
- Fluent
Do you Write?
- Fair
- Good
- Fluent
Professional Licenses, Registrations, and/or Certifications
Type State Issued Date Issued Expires Number Eligible

Click on the "+" to add more. Do not include driver's license
Applicant's Certification
I certify that all matters contained in this application are true and agree that any misleading or false statements would render this application void and would be sufficient cause for immediate dismissal in the event of employment.

I further understand that this an application for employment and that no employment contract is being offered.

I agree, if employed, to abide by alll OAHS rules and regulations. I understand that such employment is for an indefinite period of time and that the company can change wages, benefits, and conditions of employment at any time.

I hereby authorize OAHS to investigate all matters contained in this application and to contact prior employers to obtain any and all information related to my past work performance.
*
- I have read and understand the above.

References that we may contact
-Please include at least 2 professional references
-Personal references may NOT be relatives
Company Name: Contact:
Address
Street AddressCityStateZip Code
Phone# Fax# Email
Company Name: Contact:
Address
Street AddressCityStateZip Code
Phone# Fax# Email
Company Name: Contact:
Address
Street AddressCityStateZip Code
Phone# Fax# Email
I authorize Ortonville Area Health Services to check these references that I have provided as required as part of the interview process.*
- Yes

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Careers
- Employment Opportunities
  - Online Employment Application
- Physician Opportunities

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