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PROMISE EMPLOYMENT APPLICATION


Position seeking:

PERSONAL INFORMATION

Full Name:
Phone:
Email:
Address:
City, State, ZIP:

EDUCATION

Highest level of education completed:Middle School
High School/GED
College/University
Graduate School
Name of school / location:
What degree(s) have you earned?

LICENSURE INFORMATION

Where did you receive your professional training?
Dates of professional training:
Place of registration/licensure:
License number:
License status:Current
Expired
Other
If other, please explain:

EMPLOYMENT HISTORY

Are you currently employed?Yes
No

Current or Most Recent Employer

Employer name:
Location:
Phone:
Title of position:
Dates of employment:
Final pay:
Supervisor's name/title:
May we contact this employer?Yes
No
Description of duties, responsibilities and skills used:
Reason for leaving:
Liked most about job:
Liked least about job:

Previous Employer 1

Employer name:
Location:
Phone:
Title of position:
Dates of employment:
Final pay:
Supervisor's name/title:
May we contact this employer?Yes
No
Description of duties, responsibilities and skills used:
Reason for leaving:
Liked most about job:
Liked least about job:

Previous Employer 2

Employer name:
Location:
Phone:
Title of position:
Dates of employment:
Final pay:
Supervisor's name/title
May we contact this employer?Yes
No
Description of duties, responsibilities and skills used:
Reason for leaving:
Liked most about job:
Liked least about job:

ADDITIONAL INFORMATION

Indicate any languages, other than English, that you are fluent in for speaking, reading or writing:
What date would you be available to begin your employment with Promise CHC?
What schedule do you prefer?Part-time
Full-time
Are you legally eligible to work in the United States of America?Yes
No
Do you know anyone at Promise CHC?Yes
No
If so, whom?
Have you previously worked for Promise CHC?Yes
No
Do you have reliable transportation?Yes
No

PROFESSIONAL REFERENCES

Reference 1

Name
Title
Phone:
Email
Describe your relationship to this reference:

Reference 2

Name:
Title:
Phone:
Email:
Describe your relationship to this reference:

Reference 3

Name:
Title:
Phone:
Email:
Describe your relationship to this reference:

HOW DID YOU LEARN ABOUT THIS JOB?

How did you learn about this job opening?Employee referral (specify below)
Print Advertising (newspaper, shopper, etc.) (specify publication below)
Radio Advertising
Social media (Facebook/Twitter)
Promise website
Online job posting/advertising (specify online site below)
Employment agency
School/college (specify below)
Other (specify below)
If other, please specify.
Also, please specify which employee, newspaper, online site, etc., referred you.

By checking this box and submitting this electronic application, I affirm that all of the information that I have provided in the application is correct and complete to the best of my knowledge.

IMPORTANT REMINDER!

To submit the employment application, make sure you click the blue "SUBMIT" button at the bottom of this form and make sure you receive the confirmation screen before closing out the website window.

If you do not receive the confirmation screen or you receive an error message after clicking "SUBMIT" due to your application form timing out, please click the back button in your browser to return to your completed form. Then, submit the application again.

Thank you for your interest in serving at Promise Community Health Center!


RESUME SUBMISSION

If you have a resume and/or letter of intent prepared, please email them to Emily Tuschen at: etuschen@promisechc.org

Or, mail them to: Promise Community Health Center; 338 1st Ave. NW; Sioux Center, IA 51250.

Thank you!