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Employment Application

 indicates required information.

Personal Information
Present Address
For the US, enter a five or nine digit zip code. Example: ##### or #####-####
Employment Desired
**Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.
High School
College University
Tech/Business School
Other Education
Clerical Applicant Only
Licenses & Certifications
Employment History
List complete employment history starting with last employer first.
Dates Employed
Dates Employed
Dates Employed
Give the names of three non-relatives whom you have know at least one year.
First Reference
Second Reference
Third Reference
Applicant Release
Read before you sign.
I understand and agree that any offer of employment is conditional upon completing and passing medical screening based on the physical demands of the job for which I am applying, acceptable reference checks, criminal background check, and successful completion of the orientation period.
I authorize Lakeview Methodist Health Care Center to investigate all statements contained in this application and I understand that misinformation given on my employment application form and during the medical screening is sufficient cause of termination, if I am employed.
I understand that nothing contained in this employment application or the granting of an interview or in any policies, procedures, and handbooks I might receive, is intended to create an employment contract between Lakeview Methodist Health Care Center and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Lakeview Methodist Health Care Center. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason, and Lakeview Methodist retains a similar right regarding the termination of my employment.