Employment Application


Employment Application


Resume Upload Instructions:

Make sure your document is the correct file type (.txt, .rft, .pdf, .doc or .docx) and less than 2MB. (NOTE: There are 1000 kb in 1MB.)

You will see the following once your file is uploaded. You can then continue to fill out the application.

If you have issues not related to these steps please contact the website administrator at Marketing@KCH.org.

You are also welcome to download this application form and mail to Careers@KCH.org or 1330 Coshocton Road, Mount Vernon, OH 43050 with a copy of your resume.

KCH Employment Application (PDF Format)

Application Date
08/21/2018
Name, Address, Contact Information, and Basic Employment Information
Current Address
Phone
Maximum file size: 2 MB | Allowed file formats: (text, rtf, PDF, doc, docx)
Files must be less than 2 MB.
Allowed file types: txt rtf pdf doc docx.
Desired Work Schedule
Full Time – Minimum 36 hours per week | Part Time – Minimum 16 hours per week to 35 hours per week | PRN – As needed
Must be flexible, some positions may require weekends/holidays/on-call.
Employment Experience
Provide information about your employment experience, starting with your most recent position.
Most Recent Position
Length of time in position
Second Most Recent Position
Length of time in position
Third Most Recent Position
Length of time in position
Fourth Most Recent Position
Length of time in position
Fifth Most Recent Position
Length of time in position
Sixth Most Recent Position
Length of time in position
Describe any additional healthcare or specialized training (vocational, business, correspondence, etc.), job skills (computer skills, office machine skills, bookkeeping experience, foreign language, etc.), apprenticeships, and/or memberships in medical or professional organizations:
Professional Licenses and/or Registrations Held:
(Note: you must click yes or no below stating that you have additional certifications in order to view additional boxes)
First
Second
Third
Education
Provide information about your education, starting with the most recent school attended
Most Recent School:
Second Most Recent School:
Third Most Recent School:
Fourth Most Recent School:
Background Check
(A conviction of a crime will not necessarily be a bar to employment. Factors such as age at the time of the offense, type of offense, remoteness of the offense in time, and rehabilitation will be taken into account in determining effect of suitability for employment.)
Employment Statements
Knox Community Hospital is committed to administering all employment practices and personnel decisions without regard to race, color, sex, religion, citizenship, ethnicity, creed and veterans status or current or prospective status in the uniformed services, national origin, disability, genetic information, age or any other protected characteristic. The Hospital is committed to this policy. All appropriate steps are taken to ensure equal opportunity in employment with respect to all personnel actions, including, but not limited to: recruiting, hiring, compensation, benefits, education and promotion / advancement opportunities.
Applicant's Statements
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that if employed, my employment will be for an indefinite duration and that my employment can be terminated by law with or without cause, at any time at the discretion of either the hospital or myself. I understand that this status can only be altered by written contract of employment that is specific as to all material terms and is signed by both myself and the administrator of Knox Community Hospital. I also understand that I will be required to undergo a pre-employment medical exam and that a conditional offer of employment may be based on the results of this examination. I authorize persons, organizations, schools, and employers noted, or otherwise, to provide any relevant information that may be required to arrive at an employment decision; I further release said persons/organizations from liability. I specifically authorize an investigation on my background, including available criminal and other judicial records.
My typed name below shall have the same force and effect as my written signature.
(mm/dd/yyyy)
Please only click the submit button one time. It may take a few moments for the form to submit your data.