Forms

PRIME HEALTHCARE EMPLOYMENT APPLICATION

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, sexual orientation,
age veteran status, disability, or any other basis prohibited by the law. We are an Equal Opportunity Employer.
Please answer all questions.

Personal Background

Employment Desired

(Proof of identity and employment eligibility will be required upon hire)

If required, would you be willing to work (please check one box in each category)

Referral Source

Driving Record

If you are applying for a driving position, please answer the following questions:

Education

High School

College/University

Trade/Technical

Additional

Skills and Qualifactions

Employment History

List most recent position first, provide all of the following information regarding your previous employment. *Incomplete information could disqualify you from further consideration. NOTE: Applicants located in the following areas should leave the salary history section blank: California, Delaware, Massachusetts, Oregon, Pittsburgh, Puerto Rico, and New York City.
Click or drag files to this area to upload. You can upload up to 2 files.

References

Please list professional references that are not related to you (at least 3).

Illegal Use of Drugs

Certification and Acknowledgement Please read carefully before signing.


This is an equal opportunity employer. I understand that no question being asked as part of my consideration for employment is intended to be unlawful. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation by the Employer to hire me. If I am hired, I understand that either the Employer or I can terminate my employment at any time with or without any reason. All the information I have given to the Employer in considering me for employment is truthful. No other information has been concealed or intentionally omitted. If any information I have given to the Employer Is untrue or misleading, if I have concealed any information, or. adverse information is discovered through the investigation, I understand that this may result in the denial of employment, revocation of an offer of employment, or termination of employment. I understand that the Employer may decide to conduct background checks and drug screenings as part of the preemployment process. I understand that I must comply with applicable policies in order to be employed by the company. Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory: overtime, change in work location, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment. Additionally, I am aware that my employment is contingent on operational requirements.