(785) 505-5000

Employment Application - Step 1: Personal Info

All bolded fields are mandatory. You must press the Submit button below to forward your application.
Please fill out this form even if you have already sent us a resume.

Personal Information

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Last
 
First
 
Middle
 
Phone #
 
Alt/Cellular #
 
Social Security #
 
Home & Street
 
City
 
State
 
Zip Code
 
Email
 
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Applications for specific open positions will have first consideration.

Other Names Under Which You Have Worked
 
Position Desired
 
#1:
#2:
Job Type(s)
  Full-Time
Part-Time
PRN (as needed)
Temporary
Date Available For Work
 
Days and times NOT Available for Work
 
Please, List your Salary Expectations
  From spacer To      
Do you have any relatives who work for LMH?
  Yes No
If Yes, please list name & relationship
Have you ever worked for Lawrence Memorial Hospital?
  Yes No
If Yes, indicate date, description of duties
and name under which you were employed.

How did you hear about this job?
 
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In order to provide the best patient care, we need to ask you the following questions:

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Have you ever been convicted of a felony during the past 7 years?
  Yes No
Have you ever been convicted of a Healthcare related crime?
  Yes No
If Yes, Explain
Are you over the age of 18?
  Yes No
Are you legally entitled to work in the U.S. for any employer?
* Proof required upon offer of employment
  Yes No
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