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ALLEGAN COUNTY MEDICAL CARE COMMUNITY
- An Equal Opportunity Employer -
APPLICATION FOR EMPLOYMENT

Please Read Carefully

Please Print Carefully

• Applicants who need reasonable accommodation to ensure equal opportunity in the application process should immediately inform the person who provided this application form. • Persons hired by Allegan County Medical Care Community are required to present proof of identification and of their legal eligibility to work in the United States prior to beginning work. • Allegan County Medical Care Community does not return resumes, transcripts, letters of reference and other information submitted with the application process.

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In compliance with federal and State equal employment opportunity laws qualified applicants are considered for all positions without regard to race, color, creed, religion, sex, national origin, age, marital or veteran status, sexual orientation, or the presence of a non-job related medical condition or disability. The Americans with Disabilities Act requires employers to provide reasonable accommodations for known physical or mental disabilities of applicants.

PERSONAL INFORMATION

Are you 18 yr of age or older? Toggle left for "no", and right for "yes".

Are you legally authorized to work within the United States. Toggle left for "no" and right for "yes"

Type of employment deisired.

Shift Preference

Have you ever been employed with ACMCC before

Toggle left for "no" and right for "yes"

What led you to place an application with us?

Have you ever been convicted of a crime?

Have you ever been fired from a position or asked to leave?

High School

Please list education or specialized experience that relates to the position(s) for which you are applying.

Exclude names or terms that indicate, for example, race, color, religion, sex, disability, or national origin.

Check last year completed.

Did you Graduate?

College / University

Check last year completed.

Did you Graduate?

Nursing Education

Check last year completed.

Did you Graduate?

Other Areas of Education

Employment Experience

List beginning with your current or last position. Include military service assignments and volunteer activities. Exclude names or terms that indicate , for example, race, color, religion, sex, disability, or national origin.

Present / Former Employers

Dates Employed

Position / Duties

Reason for leaving.

Former Employer

Dates Employed

Position / Duties

Reason for leaving.

Former Employer

Dates Employed

Position / Duties

Reason for leaving.

Former Employer

Dates Employed

Position / Duties

Reason for leaving.

Indicate any employer(s) you do not want us to contact

If your employment records exist under another name, please specify.

Personal References

Skills

Additional Skills and Experinces

Personal References

Professional References

Required Demographic Information

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