Online Application

Minneola Healthcare Employment Application
HUMAN RESOURCE DEPARTMENT
P. O. Box 127
212 Main
Minneola, KS 67865
Phone: 620-885-4264
Fax: 620-885-4632

An Equal Opportunity Employer

Personal Data


IF HIRED, YOU WILL BE REQUIRED TO PROVIDE DOCUMENTATION VERIFYING CITIZENSHIP OR
ELIGIBILITY TO WORK IN THE UNITED STATES

Background Information


Conviction is not an automatic elimination from employment. Each case is considered individually; however, failure to identify a conviction is cause for automatic ineligibility for hire or dismissal.

Educational Background


Summarize any special skills or training that is relevant to the position you are applying for

Employment Record

Starting with your PRESENT or MOST RECENT employer, please list ALL jobs you have had including military experience for at least the past five (5) years. DO NOT omit any work experience. If you need more room, please email a Word Document with additional employer information to humanresources@minneolahealthcare.com. PLEASE COMPLETE THIS SECTION EVEN IF PROVIDING A RESUME.







PROFESSIONAL CERTIFICATION/LICENSES




References
List individuals who are familiar with your work and educational qualifications: Friends and family are not accepted.



This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, or on the basis of age, or physical or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the physical examination along with any future physical examinations, which could include a drug screening, as may be required by this institution at such times and places as the institution shall designate. I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties I would be required to perform.

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form and that I will be subject to a probationary period.

If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.