Silver Cross Hospital

The way you should be treated.™

My SilverCross

Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 1 year.
Job Posting Select Posting to Apply for:  General

Personal

Addresses

Present Address
Permanent Address

Education

High School
Undergrad School
Grad School
Other School

Employment

Employment Information
Calendar (yyyy-mm-dd)
 Full-Time  Part-Time  Registry
 Days  Evenings  Nights  Weekends
 Weekends/Holidays  Rotating Shifts  On-Call  Any Shift

Please answer all of the following questions.
1) Are you at least 18 years of age?*
2) Have you worked at this facility before?*
If yes, when?
3) Do you have any relatives or friends employed by this facility?*
If yes, please list their name, department, and relationship*
4) Are you legally eligible to work in the United States?*
5) Have you ever been involved in the substantiated abuse or neglect of children or adults under the laws of this or any other state of the United States?*
If yes, which states(s), and please explain
6) Have you been sanctioned, cited, reported, or excluded from participation in medicare, medicaid, or any other healthcare related law or regulation?*
If yes, please explain
7) Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?*
If yes, which state(s), and explain (you are not required to disclose any SEALED or EXPUNGED criminal records)

Employers

Employer
May we contact your present employer?
Prior Employer (1)
May we contact this employer?
Prior Employer (2)
May we contact this employer?
Prior Employer (3)
May we contact this employer?
Gaps in Employment
Please explain any gaps in employment longer than 3 months:

Personal Skills

Additional Information About You
Currently Licensed
Eligible for License
Currently Registered
Eligiblie for Registration
License Type:
License Number:
State:
Date (mm/yyyy):
Has your license or registration ever been suspended, revoked or placed on probation?
 
If so, please explain
 
Currently Licensed
Eligible for License
Currently Registered
Eligiblie for Registration
License Type:
License Number:
State:
Date (mm/yyyy):
Has your license or registration ever been suspended, revoked or placed on probation?
 
If so, please explain
 
Professional Certifications:
Currently Certified
Eligible for Certification
Certification Type:
State:
Date (mm/yyyy):
Currently Certified
Eligible for Certification
Certification Type:
State:
Date (mm/yyyy):

References

Please list at least 3 references that are not relatives.

Reference
Reference
Reference
Reference

Resumes

Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)

Agreement

Applicant Certification Agreement
1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained herein.
2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3. If hired, my employment is voluntary, meaning that either party can terminate employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4. Any employment offer is contingent upon my providing proof of identity and eligibility to work in the country of employ.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Signature
 
Type Name in Signature Box*:
 
 
Date: 2014-10-25 4:27:02

News

  • Find Relief for Cervical Spinal Stenosis


    Read More...
  • Childerguild to Recognize Dr. Fred Alexander & Br. James Gaffney at Annual Ball on Nov. 22


    Read More...
  • Silver Cross Encore Resale Shop Announces Christmas Opening Oct. 31 & Nov. 1


    Read More...

Social Media

Thomson Reuters Top 100 Hospitals

AAHCP Hospital of Choice

Located at 1900 Silver Cross Blvd., New Lenox, IL 60451   Main Phone (815) 300-1100

© Copyright 2014  Silver Cross Hospital. All Rights Reserved.

 

  

Physicians on Silver Cross Hospital’s Medical Staff have expertise in their areas of practice to meet the needs of patients seeking their care.  These physicians are independent practitioners on the Medical Staff and are not the agents or employees of Silver Cross Hospital. They treat patients based upon their independent medical judgment and they bill patients separately for their services.