Apply This application can be active as long as legally required. Atoka County Medical Center is an equal opportunity employer. Name *FirstLastEmail *PhoneAddressPrevious AddressCityStateZIPJob Applying ForSalary RequirementType of PositionFull TimePart TimePRNShiftDaysEveningsWeekendsNightsHolidaysDate available for work?If overtime work is required periodically, does this pose a problem for you?YesNoAre you legally eligible for employment in this country?YesNoHave you ever applied here before? if so list dates and positionsHave you ever been employed here before? If so list dates and positionsIf you have any relatives currently employed by Atoka County Medical Center, please list their namesHow did you learn of this position?Job InformationDo you have adequate means of transportation to get to work on time each day and when called in on short notice during normal working hours? YesNoAre you able to perform the essential, job related functions of the position for which you are applying with or without reasonable accommodations?YesNoI need more information about essential dutiesHave you been convicted of a crime and/or released from confinement following a conviction for any criminal offense? Arrests or charges that have been expunged need not be disclosed. If yes please provide dates and details:Are you presently charged with any violation of the law? If yes, give date, place and nature of each such event:Are you currently excluded from participation in any federally funded healthcare program - including Medicare and Medicaid - and are you aware of any potential exclusion from a federally funded health program?YesNoHave you ever been bonded?YesNoIf necessary what is the best time to call you?May we contact you at work? If so list phone number.Is there any name(s) under which you have been known?If you are licensed. has your license ever been suspended or revoked or are you currently involved in any preceding that could affect your license or certification?YesNoIs this application a request for reemployment following an extended military leave of absence from this company?NoYesHave you ever entered into an agreement with any former employer or other party such as a non competition agreement that might in any way restrict your ability to work for our company? If yes please explainIf they have been explained to you, are you able to meet the attendance requirements for this position?YesNoWork HistoryCurrent or most recentEmployerPrevious Job TitleDate Previous Job StartedDate Previous Job EndedPrevious Job DescriptionWageReason for leavingSupervisor NamePhoneMay contact this employer?YesNo1st Previous EmployerPrevious Job TitleDate Previous Job StartedDate Previous Job EndedPrevious Job DescriptionWageReason for LeavingSupervisor NamePhoneMay we contact this employer?YesNo2nd PreviousEmployerPrevious Job TitleDate Previous Job StartedDate Previous Job EndedPrevious Job DescriptionWageReason for LeavingSupervisor NamePhoneMay we contact this employer?YesNoJob History QuestionsPlease explain any gaps in employment other than those due to injury, illness or disability Have you ever been asked to resign from a job? If so please explainWork ReferencesName 1Phone 1RelationshipName 2Phone 2RelationshipName 3Phone 3RelationshipEducation/TrainingSchool Name/AddressNo. of YearsCourse or MajorDiploma or DegreeProfessional and Technical ApplicantsProfessional License NumberLicense TypePlace of IssueExpiration DateTo what job-related organizations do you belong? (trade, professional, etc) Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.List any special accommodations, awards, publications, etc. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.Please list any additional information necessary to describe your full qualifications (i.e., special equipment, computer software experience, typing speed, or specialty areas such as ER, ICU Surgery, etc) Disclaimer *I certify that this application was completed by me and that all entries on it and all information contained in (this application, resume, and any supplement thereof) is CORRECT and COMPLETE to the best of my knowledge. In the event of employment, I understand that false, misleading, or omitted information given in my application (or during interviews) may result in termination. I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision. I understand that an investigation may be made and information maybe obtained through interviews with the personal references and past employers listed. I further understand said background check may also involve Atoka County Medical Center obtaining a criminal background report, investigative consumer report, and/or driverâs license verification. I hereby authorize Atoka County Medical Center., if they wish, to make such inquiriesDisclaimer *I hereby release all parties, including but not limited to Atoka County Medical Center, personal references, and previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Atoka County Medical Center concerning me or any action Atoka County Medical Center takes on the basis of such information.Disclaimer *I understand that this application is not a contract of employment and that any resulting employment relationship is for no fixed period of time and is terminable at any time and for any reason by Atoka County Medical Center, or by me. I further understand that statements which may be contained in policies, practices, handbooks, or other Atoka County Medical Center material do not create any guarantee of employment and that Atoka County Medical Center has the right to modify, amend, or terminate policies, practices, benefits plans, or other programs within the limits and requirements imposed by law. I understand that no representative of Atoka County Medical Center, other than a corporate officer, has the authority to enter into any agreement for any specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing, signed by an authorized officer, and be specifically for employment, to be binding on Atoka County Medical Center.PhoneSubmit This application will be considered active for 30 days after the position for which you have applied has been filled after which you will have to fill another one out.