Provider Recruitment

Personal Information
Professional Licenses Held
General Information
(If you do not know the essential functions, please ask to see the job description prior to completion)
A conviction of a crime will not necessarily be a bar to employment. Factors such as age at time of the offense, type of offense, remoteness of the offense in time, & rehabilitation will be taken into account in determining effect of suitability for employment
(Please exclude all information relating to age, sex, race, religion, color, national origin, Veteran's status, or disability). Attach additional documentation if necessary

Please read the following statement carefully

I hereby affirm that the information provided on this application, accompanying Curriculum Vitae, and any other materials which I submit to further the employment process is true and complete to the best of my knowlegde. 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 also understand that I will be requierd to undergo an Occupational Examination Assessment which includes a drug screen, a criminal background investigation, and a credit check and that a conditional offer of employment will be based on the results of this examination and investigations.

I authorize persons, organizations, schools and employers noted, or otherwise, to provide any relevant information that may be required at the sole discretion of Knox Community Hospital to arrive at an employment decision; I further release said persons/ organizations from liability due to the release of this information.

*Application  is only considered complete when accompanied by current Curriculum Vitae.

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