North Valley Hospital
Growing Healthcare Close to Home

Online Application

 

Online Job Application

Personal Data
Please furnish all information requested on this form. If you wish to supply additional education or work history information, submit separate sheet.
Name *
Name
Your Phone Number *
Your Phone Number
Physical Address *
Physical Address
Mailing Address
Mailing Address
If different than physical
If you are under 18 years of age, can you provide required proof of eligbility to work?
Are you a military veteran? *
If yes, please list under Work Experience section.
How did you learn about this position opening? *
Do you have any relatives employed here? *
If yes, please indicate name(s), and what position they hold.
Have you been previously employed here? *
If yes, please list dates and position(s) below.
Work Skills
Please mark each box that describes your experience/training.
Business
General
Patient Care
Work Availability *
If temporary or on-call, indicate when available.
Indicate shift(s) you will work *
Will you rotate shifts? *
Will you work weekends? *
Indicate days you are available to work. *
Job Performance Ability
Are you able to perform all the essential function of the postition for which you are applying? *
Personal References
Please include first and last name, and phone number.
Please include first and last name, and phone number.
Please include first and last name, and phone number.
Education
Did you earn your diploma or GED? *
College or Schools after high school.
This includes any job related education or training in military service.
Work Experience
List most recent employer first. Include at least past five (5) years, and account for any time gaps in your employment history, including any military service. (Attach additional if ncessary.)
Employer's Phone Number
Employer's Phone Number
Employer's Address
Employer's Address
May we contact this supervisor?
Employer's Phone Number
Employer's Phone Number
Employer Address
Employer Address
May we contact?
Employer's Phone Number
Employer's Phone Number
Employer Address
Employer Address
May we contact?
If so, please list previous name(s) and which employer knows you as this name.
Are there any responsibilities that will prevent you from meeting attendance requirements?
If yes, please explain.
If you answered yes on the previous question, please explain what commitments will affect your ability to meet the attendance requirements.
PROFESSIONAL REGISTRATION/LICENSURE
If you do not have a required registration or license, have you applied for one?
If not licensed in Washington State, have you applied for reciprocity?
If yes, please explain in the next section.
Have you been convicted of, or do you have charges pending for any crime? *
Please ready carefully:
I certify that the information set forth in this Application for employment is true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application or failure to furnish all requested information shall be considered sufficient cause for my dismal. I understand my employment shall be contingent upon proof of identity and verification of eligibility for employment in the United States in accordance with Immigration reform and Control Act of 1986. I further understand that my employment is contingent upon the checking of references furnished by me, any results of a Criminal History Information check concerning any convictions for any crime against person, or any civil adjudication for sexual assault, physical abuse or exploitation of a minor, and positive testing results for illegal drug use. I consent to and authorize this employer and its personnel to request information concerning my previous employment record as indicated on this Application and conduct Criminal History Information check concerning any conviction for any crime against persons, or any civil adjudication for sexual assault, physical abuse or exploitation of a minor and to drug/alcohol screening. I hereby release all parties and persons connected with any request for information from all claims, liabilities, and damages for whatever reason arising out of furnishing such job related information. North Valley Hospital is an equal opportunity employer and does not discriminate on the basis of gender, age, race or color, religion, marital status, national origin, disability or veteran status, sexual orientation or gender preference. Interviews are given on a competitive basis, using job-related factors, after a written application has been received and reviewed. Because of the large number of applications received, not everyone who applies for an open position will be interviewed.
I agree and understand this statement. *
All fields marked with an asterisk* MUST be completed before submitting the application. If there are incomplete fields the application will not be successfully sent, so you must go back through and check for any sections highlighted in red and complete them. If you are having problems submitting your application please call 509-486-3163 for assistance.
Type your full name below, which acts as an electronic signature.