Career Opportunities Career Opportunities at FSH Keywords Location Remote positions only Full Time Your browser does not support JavaScript, or it is disabled. JavaScript must be enabled in order to view listings. Load more listings Employment Application Employment ApplicationQualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of non-job related medical condition or handicap, or any other legally protected status.Please complete in full. Please print.Name: Street Address: City, State, Zip: SS# Driver License State & Number Email Address: Home Phone: Cell Phone: Position applying for: Status Desired? FT PRN Date available to begin work: Are you prevented from lawful employment because of visa or immigration status? If NO, proof of citizenship or immigration status will be required upon employment. Yes No Are you over the age of 18? Yes No Are you available to work overtime? Yes No Are you available to work weekends? Yes No Have you worked for First Surgical in the past? Yes No Are you presently employed? Yes No If yes, may we contact your present employer? Yes No Do you have friends or relatives employed First Surgical? Yes No (If yes, please list below)Have you, since the age of 18, ever been convicted of, or have you pleaded guilty or no contest to a misdemeanor or felony charge (excluding minor traffic violations)? Yes No If yes, please explain. A conviction will not necessarily bar you from employment. Convictions will be reviewed with respect to date, circumstances and nature of offense, however, failure to disclose convictions will result in disqualification of your application.EDUCATION AND TRAINING:High School Name and Location Major of Field Years Completed 9 10 11 12 Graduated Yes No College Name and Location Major of Field Years Completed 1 2 3 4 Graduated Yes No Other Name and Location Major of Field Years Completed Graduated Yes No MILITARY RECORD:Branch: Date Entered: Date Discharged: Special School/Training in Military:PROFESSIONAL LICENSURE/CERTIFICATION:(this information is required for all medical personnel, paraprofessionals & professionals) Click on the (+) icon to add more fieldsLicense/CertificationIssued by: (State or other authority)License/Cert #Date IssuedDate of ExpirationComments Click on the (+) icon to add more fieldsWORK EXPERIENCE:Please list your work experience for the past five (7) years beginning with your most recent job held.Name & Address of Employer Phone number: Type of Business: Last Job Title: Supervisor: Employment DatesFrom:To:Salary: Reason for leaving (be specific)List duties performed/skills used or learned during your employment:Name & Address of Employer Phone number: Type of Business: Last Job Title: Supervisor: Employment DatesFrom:To:Salary: Reason for leaving (be specific)List duties performed/skills used or learned during your employment:Name & Address of Employer Phone number: Type of Business: Last Job Title: Supervisor: Employment DatesFrom:To:Salary: Reason for leaving (be specific)List duties performed/skills used or learned during your employment:Please explain any gaps in employment exceeding 60 days:Please list at least three professional references:NameContact PhoneCompanyPositionComment Click on the (+) icon to add more fieldsRELEASE FOR BACKGROUND INVESTIGATION AND UNDERSTANDING OF EMPLOYMENT RULESPLEASE READ CAREFULLYAPPLICATION FORM WAIVER In exchange for the consideration of my job application by US Health Partners d/b/a First Surgical Hospital (hereinafter called “the Company”), I agree that: My employment is terminable “at-will”. Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the Company or otherwise to change in any respect the employment-at-will relationship between me and the Company, and that relationship cannot be altered. Either the Company or I may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact. I understand that, in connection with the routine processing of my employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. If employed, I understand that I am required to abide by all Company rules, regulations and policies and agree to engage in no outside activity which would involve a material conflict of interest with, or which could reflect adversely on the Company. I understand this decision is to rest with the Company. If employed, I agree to hold in strictest confidence any information concerning the Company, its patients, and its principals which may come to my knowledge. I certify that the facts and information given in this Application are true and complete to the best of my knowledge. In the event that they are inaccurate or incomplete, this will cause rejection of my Application and in the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in termination of employment.Signature:Date:RECRUITMENT SOURCE INFORMATIONPlease check the box that shows how you first learned of this job opening: Friend or Relative (specify) Current First Surgical Employee (specify) Organization or Group (specify) Advertisement (specify newspaper or publication) Other Means (specify) All employment applications are retained for a period of one year only.Applicant Information ReleaseI hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will release and hold US Health Partners d/b/a First Surgical Hospital, any former employers, educational institutions, and any other persons giving references harmless for the exchange of this information and any other reasonable and necessary information incident to the employment process.I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will release and hold US Health Partners d/b/a First Surgical Hospital, any former employers, educational institutions, and any other persons giving references harmless for the exchange of this information and any other reasonable and necessary information incident to the employment process.Signed:Printed Name:Date:
