APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION DATE OF APPLICATION: _ _ _ _ _ _ _ _ _ _ _ _ __
Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Last First Middle Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Street (Apt) City/State Zip Alternative Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Street City/State Zip Contact Information: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Home Telephone Mobile Telephone E-mail Passport No: How did you learn about our hospital?
POSITION APPLIED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Available Start Date: _ _ _ _ _ _ _ _ _ _ _ _ ___ Desired Pay Range: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Are Currently Employed: _ _ _ _ _ _ _ _ _ _ ___ Hourly or Salary
EDUCATION Name and Location Graduate?-Degree? Major/ Subjects of Study High School
College or University
Specialized Training, Trade School, etc…
Other Education
Please list your areas of highest proficiency, special skills or other items that may contribute to your
abilities in performing in the above mentioned position.
PREVIOUS EXPERIENCE Please list beginning from most recent Dates Employed Company Name Location Role/Title
Job notes, tasks performed and reasons for leaving:
Dates Employed Company Name Location Role/Title
Job notes, tasks performed and reasons for leaving:
Dates Employed Company Name Location Role/Title
Job notes, tasks performed and reasons for leaving:
PERSONAL REFERENCES: list three individuals not related to or living with you, who can attest to your qualifications and fitness for this position
Name
Address
Telephone
Years known
Information to the Applicant: As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may take a written request for information derived from the checking for your references.
If necessary for employment, you may be required to: provide your birth certificate or other proof of authentication to work in USA, have a physical examination and / or a drug test, undergo a criminal background check, and sign a conflict of interest agreement and abide by its terms.
I hereby authorize the above listed employers and references to release information as to my qualifications for employment at St. Elizabeth Hospital
I understand and agree to the information above.
Signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Mr. Todd Smith, President St. Elizabeth Community Hospital United States of America.
NOTE: PLEASE DO NOT APPLY IF YOU DON'T HAVE INTERNATIONAL PASSPORT

INTERVIEW FORM FOR EMPLOYMENT 1. How can you describe yourself?
2. What's your greatest strength?
3. What's your greatest weakness?
4. Tell me about a time when your course load was heavy. How did you complete all your work?
5. Tell me about a time when you had to accomplish a task with someone who was particularly difficult to get along with:
6. How do you accept direction and, at the same time, maintains a critical stance regarding your ideas?
7. What are some examples of activities and surroundings that motivate you?
8. Tell me how you can handle an ethical dilemma?
9. What post are you interested in?
10. Why do you want this particular post?
11. What do you see yourself doing after five years?
12. How do you make yourself indispensable to this Organization?
13. Why do you want to work for this Organization?
Signed by:
Mr. Todd Smith, President St. Elizabeth Community Hospital
United States of America