Cobleskill Regional Hospital Employment Application

Cobleskill Regional Hospital Employment Application

Welcome to Cobleskill Regional Hospital (CRH). We appreciate your interest in our organization. We encourage you to provide all information requested on this application. We are an equal employment opportunity employer. Candidates are chosen on the basis of ability without regard to race, color, sex, age, religion, creed, national origin or ancestry, citizenship, sexual orientation, physical or mental disability, gender identity or expression (including transgender status), marital status, military or veteran status, genetic predisposition or carrier status, status as a domestic violence victim, familial status, or any other status protected by law. Any applicant requiring an accommodation to participate in the application or interview process should notify Human Resources.

Personal Information
Address
Employment Desired
Schedule Preferred
Are you legally authorized to work in the US?
Please note: you will be required to furnish proof of lawful work status if you are extended a job offer.
Will you, now or in the future, require sponsorship for employment visa status (e.g., H-1B, TN, etc.)?
Are you under the age of 18?
Have you ever been convicted of a crime (misdemeanor or felony)?
Please note: A prior conviction may or may not preclude employment. O'Connor Hospital will evaluate the nature of criminal offense, its relationship to the position sought, and other lawful factors. Failure to disclose a prior conviction is considered falsification of the employment application and will result in denial of employment.
Have you ever been employed by CRH? If yes, please list when and in what role.
Did a CRH employee refer you to this position? If yes, please provide their name.
Are you currently listed on the Office of Inspector General (O.I.G.) or General Services Administration (“GSA”) exclusion list from Federal Health Care Programs?
Education
Graduated?
Graduated?
Graduated?
Issuing State
Have any of your licenses, registrations, or certifications ever been restricted, revoked, or suspended, or is any disciplinary action currently pending against your license, registration, or certification?
Employment


Please list three (3) references from previous jobs:
Affirmation, Authorization, and Release
I understand that employment at Cobleskill Regional Hospital is subject to proof of eligibility to work in the United States, providing a valid record of applicable immunizations and passing a physical examination, as required by the Public Health Law, satisfactory references and appropriate credentialing, if applicable. I also understand that employment at Cobleskill Regional Hospital is subject to a criminal background check and drug screen.

I understand that, as part of the application process, Cobleskill Regional Hospital will verify my education, employment history, licensure, and other items on this application.  I authorize the employers, educational institutions, and references named above to provide Cobleskill Regional Hospital with information and opinions concerning my educational background, previous work experience, and work-related qualifications, behavior, and character.  I understand that Cobleskill Regional Hospital will use the information and opinions disclosed by these organizations and individuals to evaluate my suitability for employment, and that information and opinions provided may include both favorable and unfavorable material.   I hereby release each individual reference and each of my current and former educators and employers, and their respective agents and employees, from any and all claims and liabilities related to the information and opinions they provide to Cobleskill Regional Hospital, and I hereby release Cobleskill Regional Hospital, its employees and agents, from all claims and liabilities related to its use of the information and opinions provided.

I understand if I am hired by Cobleskill Regional Hospital, my employment is terminable at will, with or without cause, based on the employment needs of Cobleskill Regional Hospital.
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One file only.
100 MB limit.
Allowed types: gif jpg png tif txt rtf html odf pdf doc docx.