Grace Hospital

Apply Online

Please fill out the form below to apply online. If you would like to send a resume, please send an attachment to mchentnik@gracehospital.org

Position Applying For
First Name
Last Name
Address
City
State
Phone Number
Email
Social Security Number
I am Interested In
I am Interested In
How were you referred to Grace Hospital
Have you worked here before
If you are under 18 years of age, can you provide required proof of your eligibility to work
Are you legally eligible for employment in the United States

Employment History- List below all present and past employment, beginning with the most recent

#1
From	To
Employer
Job Title
Telephone
Address
Supervisor
Responsibilities
Reason for leaving
Starting Pay
Ending Pay

#2
From	To
Employer
Job Title
Telephone
Address
Supervisor
Responsibilities
Reason for leaving
Starting Pay
Ending Pay
May We contact your present employer for a reference?	Yes No
Were you discharged for cause by any of the above employers?	Yes No

Skills and Qualifications - Summarize special skills and qualifications aquired from employment or other experiences that may qualify you for work with Grace Hospital (i.e. office machines, typing rate, shorthand speed):

Education Background

High School



College



Other



Licenses, Registrations and/or Certifications
Type
State Issued
Date
Number
Professional Organizations:

References

Reference 1



Reference 2



Reference 3

Affidavit & Pre-Employment Inquiry Release

I certify that my answers to all of the foregoing are true and I recognize that if hired my employment at any time in the future is subject to termination without notice should any of the above statements be found false or inaccurate. I hereby agree to submit to medical examinations, including drug testing, both as a condition of employment following an offer of employment and as a condition to continued employment.

In connection with my application for employment with Grace Hospital, I understand that investigative background inquiries are to be made on myself which may include but are not limited to: consumer credit, criminal convictions, motor vehicle and driving, education and/or degrees. These reports will include information as to my character, work habits performance , and work experience along with reasons for termination of employment from previous employers. Further, I understand that Grace Hospital will be requesting information from various Federal, State, County, City and other agencies which maintain records concerning my past activities and experiences. I also understand that Grace Hospital may perform reference checks on my past employment which includes contacting past and/or present employers.

I authorize, without reservation, any party or agency contacted be Grace Hospital to furnish the above mentioned information. I hereby consent to Grace Hospital obtaining the above information by contacting past and/or present employers, colleges and/or universities attended, and/or State of Ohio Bureau of Criminal Investigation and Identification.

I understand that my employment is "at-will" and therefore just as I may terminate my relationship with Grace Hospital at any time for any reason, grace Hospital expressly reserves the right to terminate my employment at is sole discretion, with or without just cause. I understand that neither this Application of Employment nor any other communications by a management representative is intended to, in any way, create a contract of employment.

I accept

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