We consider applicants for all positions without unlawful discrimination on the basis of protected status, including: race, color, religion, sex, national origin, age, marital status, Vietnam era or disabled veteran status, or disability.


Please provide the following information. A resume providing this information may be submitted only as supplement.
NOTE: Start with present or most recent job. Furnish dates and explanation for each period of unemployment of one month or more.





Exclude organizations which indicate race, color, religion, gender, national origin, disability, or other protected status.


Please provide complete information for three professional references


I understand that federal Law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand that any offer of employment that may be made by Prevost Memorial Hospital (PMH) is conditioned on the results of a post-offer physical examination and drug screening through urinalysis. The medical provider(s) of said examination will be designated by PMH and will be at the company's expense.

I understand that neither this application not any handbook or personal policies manual I receive from PMH is intended to create a contract for employment for any particular duration or with any particular terms and conditions.

I understand that employment with PMH is at will and may be terminated at any time by the employer or the employee for any reason not prohibited by law unless different terms and conditions are set forth in writing signed by the Human Resources Director and the Administrator of PMH.

I hereby agree not to share my assigned User ID/Password with anyone else. Any use of discussion of information on the Hospital Computer Systems or its product must be approved by Department Managers. I will follow any rules set by the IT Department pertaining to the Informations Systems.

I certify that all statements herein are true and I understand that any falsification or willful omission of information in the employment process may result in dismissal or refusal of employment.
*Please provide your full professional name for your signature
I authorize the release of any information in your files concerning my enrollment or employment in your organization to representatives of PMH and I release any organization or individual providing such information to PMH representatives from any and all liability for damage resulting therefrom.
*Please provide your full professional name for your signature