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Excellence in Community Healthcare.

(334) 283-6541   

805 Friendship Road - Tallassee, Alabama 36078

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CONTACT INFORMATION





CURRENT OPEN POSITIONS FOR WHICH YOU ARE APPLYING

  •   Per Diem
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  •   PRN
  •   Full TIme
  •   Part Time
  •   Temporary
  •   Weekend
  •   Day
  •   Night
  •   Evening
  •   Rotation

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  •   State Employment Commission
  •   Agency
  •   Job Listing
  •   Current Employee
  •   Internet
  •   Advertisment
  •   School
  •   Job Fair
  •   Other
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  •   First
  •   Second
  •   Third

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EDUCATIONAL HISTORY
TYPE OF SCHOOL
Name of School (City, State)
Last Year Attended
Degree or Certificate

HIGH SCHOOL
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COLLEGE
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COLLEGE
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GRADUATE SCHOOL
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OTHER
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WORK HISTORY
CURRENT/MOST RECENT EMPLOYMENT


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1ST MOST RECENT EMPLOYER




2ND MOST RECENT EMPLOYER




PROFESSIONAL REFERENCES (Other than Relatives)
Give references who have good knowledge of your work.






Please Review and Acknowledge That You Understand The Following. In making application for employment:
* I certify that the information in this application is true and complete for all practical purposes. It may be verified by the facility or any affiliate. Should a position be offered and later it is found that the information is significantly untrue, incomplete, or misrepresented, I understand and agree that the facility or its affiliates are relieved of all commitments, financial or otherwise pertinent to employment, and that I am subject to immediate discharge without recourse.
* I understand that an investigative report may be made by a consumer reporting agency to include information as to my character, general reputation, personal characteristics, and mode of living, whichever may be applicable. If such an investigative report is made, I understand that I will receive notice that such a report has been requested, and that I will have the right to make a written request for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
* I UNDERSTAND AND AGREE THAT ANY EMPLOYEE HANDBOOK WHICH I MAY RECEIVE WILL NOT CONSTITUTE AN EMPLOYMENT CONTRACT, BUT WILL BE MERELY A GRATUITOUS STATEMENT OF FACILITY POLICIES.
* I understand that the facility reserves the right to require its employees to submit to blood tests or urinalyses for alcohol or drug screens, or to allow inspection of bags (including purses or briefcases) or parcels brought into or taken out of the facility. I understand that refusal to submit to a urinalysis or blood test, when requested to do so, may result in termination of my employment.
* Compliance with this facility's Substance Abuse Policy is a condition of employment. This hospital requires that every newly hired employee be free of alcohol or drug abuse. Each offer of employment is contingent upon successfully completing a urinalysis test/screen for alcohol and drugs in accordance with hospital policy. Continued employment is also contingent upon compliance with the hospital's Alcohol and Drug Abuse Policy.
*I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY THE FACILITY, MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I, OR THE FACILITY WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE ADMINISTRATOR OF THE FACILITY.
Release: I hereby authorize any prior employers to provide such information concerning my employment with them as may be requested, and also authorize the Registrar/Placement Office of all educational institutions attended to release an official copy of my transcript and, if available, faculty appraisals. I also authorize any appropriate licensing board to release full information concerning my licensure status and my licensure history.

I agree that I will settle any and all claims, disputes or controversies arising out of or relating to my application for employment, employment or termination of employment with the employer exclusively by final and binding arbitration and before a neutral Arbitrator and in accordance with the rules and procedures for employment disputes adopted by the employer. Such claims shall include those that could be brought in a court of law under any applicable federal, state or local statutory or common law, such as the Age Discrimination in Employment Act, Title VII of the Civil Rights Act of 1964, as amended, including the amendments of the Civil Rights Act of 1991, the Americans with Disabilities Act, the Family and Medical Leave Act, state civil rights acts, the law of contract and the law of tort.
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APPLICATION ADDENDUM
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* Note: Answering "Yes" to any of these questions may not necessarily disqualify you from the position desired. Each action and explanation will be weighted / considered in relationship to the position for which you are applying. HRDATA\FORMS\APPLKT\ADDENDUM


© 2017, Community Hospital, Inc.
805 Friendship Road
Tallassee, AL 36078
P: (334) 283-6541