Apply Online Employment Application We appreciate your interest in our organization and assure you we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in future upgrading. This facility is an Equal Opportunity Employer. Employment, educational opportunities and promotions in all job classifications are without regard to race, creed, sex, age, national origin, religion, disabilities or military status. Position Applying For:*Name* First Middle Last Have you ever been employed or attended school under another name?*YesNoPlease indicate former name.*Email* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you at least 18 years of age?*YesNoWhat is your age?*Date Available for Employment* Date Format: MM slash DD slash YYYY Minimum Salary DesiredHours desired?Full-TimePart-TimeShifts you are available to work? Days Evenings Nights Weekends Holidays Have you ever been employed at Winner Regional Health?*YesNoWhen and in what capacity?*Who referred you to our organization?* Newspaper Internet Our Website Employee HospitalCareers.com School On My Own Facebook Please specify reference:*Please specify employee name:*Upload Resume and/or Cover Letter Drop files here or Accepted file types: pdf. General InformationHave you ever been convicted of, found guilty of, or pleaded guilty to, a felony of any kind?*YesNoPlease explain.*Have you ever been discharged or forced to resign from any position?*YesNoPlease explain.*Have you ever had your privilege to practice revoked or reduced or otherwise restricted?*YesNoN/APlease explain.*Has your license or certification ever been denied, revoked, suspended, stipulated, placed on probation or otherwise subject to any type of disciplinary action?*YesNoN/APlease explain.*Educational HistoryCheck all education levels you have completed or are currently working on?* High School Professional/Trade School Associate or Bachelor Degree Graduate Degree High School NameHigh School Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State High school course of study?Are you currently enrolled in high school?YesNoDid you graduate high school?YesNoHighest High School Grade Completed89101112GEDCollege NameCollege Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State College course of study?Are you currently enrolled in college?YesNoDid you graduate college?YesNoCollege Grade CompletedFreshmanSophomoreJuniorSeniorGraduate School NameGraduate School Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Graduate school course of study?Are you currently enrolled in graduate school?YesNoDid you complete graduate school?YesNoGraduate school degree(s)?Professional/Trade School NameProfessional/Trade School Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Professional/Trade school course of study?Did you complete professional/trade school?YesNoProfessional/Trade school degree(s)/certificate(s)?Have you served in the military?YesNoAre you currently active?*YesNoBranch of MilitaryStarting Date of Service Date Format: MM slash DD slash YYYY Ending Date of Service Date Format: MM slash DD slash YYYY Highest Rank AchievedDutiesPlease list special skills and/or qualifications which may be relevant to the position you are applying for:Professional Licensure/Certification/RegistrationDo you have a Professional Licensure/Certification/Registration?YesNoType*Number*State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Expiration Date* Date Format: MM slash DD slash YYYY Do you have a second Professional Licensure/Certification/Registration?*YesNoSecond Type*Number (2)*State (2)* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Expiration Date (2)* Date Format: MM slash DD slash YYYY Employment HistoryPlease include four employers if available.Are you currently employed?YesNoMay we contact your present employer?YesNoCompany NamePosition/TitleAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date Date Format: MM slash DD slash YYYY End Date Date Format: MM slash DD slash YYYY List of DutiesReason for LeavingSupervisor Name First Last Supervisor PhoneHourly Rate/SalarySecond EmployerCompany Name (2)Position/Title (2)Address (2) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date (2) Date Format: MM slash DD slash YYYY End Date (2) Date Format: MM slash DD slash YYYY List of Duties (2)Reason for Leaving (2)Supervisor Name (2) First Last Supervisor Phone (2)Hourly Rate/Salary (2)Do you have a third employer to list?YesNoThird EmployerCompany Name (3)Position/Title (3)Address (3) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date (3) Date Format: MM slash DD slash YYYY End Date (3) Date Format: MM slash DD slash YYYY List of Duties (3)Reason for Leaving (3)Supervisor Name (3) First Last Supervisor Phone (3)Hourly Rate/Salary (3)Do you have a fourth employer to list?YesNoFourth EmployerCompany Name (4)Position/Title (4)Address (4) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date (4) Date Format: MM slash DD slash YYYY End Date (4) Date Format: MM slash DD slash YYYY List of Duties (4)Reason for Leaving (4)Supervisor Name (4) First Last Supervisor Phone (4)Hourly Rate/Salary (4)ReferencesSchool or personal references we may contact. (Do not list relatives.)Name* First Last Title/OccupationCompany NameAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Second ReferenceSchool or personal references we may contact. (Do not list relatives.)Name (2)* First Last Title/Occupation (2)Company Name (2)Address (2) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (2)*Third ReferenceSchool or personal references we may contact. (Do not list relatives.)Name (3)* First Last Title/Occupation (3)Company Name (3)Address (3) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (3)*Voluntary Affirmative Action InformationSexMaleFemaleEthnicityCaucasianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific IslanderAmerican Indian/Alaskan NativeAsianTwo or more racesPlease mark the appropriate veteran status:Active MilitaryDisabled VeteranOther Protected VeteranArmed Forces Service Medal VeteranRecently Separated VeteranApplicant’s StatementI hereby give Winner Regional Healthcare Center the right to investigate my past employment, education and activities. I release from all liability all persons, schools, companies and corporations who supply such information. I release Winner Regional Healthcare Center against any liability that might result from such investigation. I understand that any false answer or statements or implications I might make in this application or in any other required document shall be considered sufficient cause to deny employment or for discharge if already employed. I also understand that nothing contained in this application or in the granting of an interview is intended to create an employment contract between Winner Regional Healthcare Center for employment or for any benefit. I have received no promise regarding employment and I understand that no such promise or guarantee is binding on Winner Regional Healthcare Center unless an employment relationship is established. I understand that I have the right to terminate my employment at any time and that Winner Regional Healthcare Center has the same discharge rights. I understand that if offered a position with Winner Regional Healthcare Center, I will be required to submit to a pre-employment health assessment, drug screening and background check as a condition of employment. I understand unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. Also, if hired at Winner Regional Healthcare Center, prior to my first day of work, I will be required to verify that I am either a U.S. citizen or a legal resident foreign national.For the above statement:*I Accept, Submit My ApplicationYou must accept the terms of the agreement to submit your application. If you do not click Accept, your application will not be saved or submitted. 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