Application for Employment

Current TFHS employees click here to apply.

Questions marked with an asterisk (*) are required.

Please consider printing a copy of this page for your records before you click Submit.

* First Name:

Middle Initial:

* Last Name:

* Country:

* Current Street Address or PO Box:

* City:

* State or Province:

* Zip or Postal Code:

* Primary Phone:

(xxx) xxx-xxxx

Alternate Phone:

(xxx) xxx-xxxx

* Email Address:

Message Phone (if different from telephone number above)

* Shifts Available?

Days

PM

Nights

* Are you available weekends?

Yes No

* Status applying for?

Full Time

Part Time

Short Hour

Per Diem

Casual Part Time

Temporary/Seasonal

* Have you previously applied for or worked at Tahoe Forest Hospital District?

Yes No

If yes, provide previous dates of employment or position applied for and approximate date.

Referral Details:

* If you are under 18 years of age, can you produce a work permit if hired?

Yes

No

Not Applicable

* The Immigration Reform and Control Act of 1986 states, offers of employment are conditioned upon satisfactory proof of identity and legal ability to work in the United States. If hired, can you furnish proof that you are legally permitted to work in the United States?

Yes No

* Have you ever been involuntarily terminated or forced to quit any prior employment?

Yes No

If so, explain.

If an offer of employment is extended, a background check will be conducted.

* Earliest date you can begin employment:

mm-dd-yyyy

Latest date to end employment:

mm-dd-yyyy

If you are applying for a seasonal job, please enter the latest date you can end employment.

Select the positions you are applying for:

First Choice

Second Choice

Third Choice

* If employed in the position for which you have applied, would you be in a supervisory, subordinate, or co-worker (within same department) relationship to any relative or member of your household?

Yes No

* After viewing the online job description, can you perform the essential functions of the job, with or without reasonable accommodation?

Yes No

Please enter the following information for your education.

College or University

Name of School:

Location:

Kind of Course/Major Subjects:

Degrees Conferred:

Graduate School

Name of School:

Location:

Kind of Course/Major Subjects:

Degrees Conferred:

Other (military, apprenticeship, or vocational)

Name of School:

Location:

Kind of Course/Major Subjects:

Degrees Conferred:

Professional Licensure

License/Certification:

State/License #:

Date/Year Issued:

Expiration Date:

mm-dd-yyyy

Restrictions:

License/Certification:

State/License #:

Date/Year Issued:

Expiration Date:

mm-dd-yyyy

Restrictions:

License/Certification:

State/License #:

Date/Year Issued:

Expiration Date:

mm-dd-yyyy

Restrictions:

* Have you ever been excluded from participating, as a Service Provider or Contractor, in the Medicare or Medicaid program?

Yes No

Work History

Start with most recent employment first. List jobs in last 5 years. Please account for periods of unemployment.

* Current or Most Recent Employer

* Employer Name:

* Position Title:

* Job Duties:

* Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

* Reason for leaving:

* Mailing Address:

Mailing Address (cont.):

* City:

* State or Province:

* Zip or Postal Code:

* Phone:
(xxx) xxx-xxxx

* Supervisor:

Supervisor's E-mail Address:

* MAY WE CONTACT CURRENT EMPLOYER?

Yes No

Second Employer

Employer Name:

Position Title:

Job Duties:

Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

Reason for leaving:

Mailing Address:

Mailing Address (cont.):

City:

State or Province:

Zip or Postal Code:

Phone:
(xxx) xxx-xxxx

Supervisor:

Supervisor's E-mail Address:

* MAY WE CONTACT THIS EMPLOYER?

Yes

No

Not Applicable

Third Employer

Employer Name:

Position Title:

Job Duties:

Start Date:

mm-dd-yyyy

End Date:

mm-dd-yyyy

Reason for leaving:

Mailing Address:

Mailing Address (cont.):

City:

State or Province:

Zip or Postal Code:

Phone:
(xxx) xxx-xxxx

Supervisor:

Supervisor's E-mail Address:

* MAY WE CONTACT THIS EMPLOYER?

Yes

No

Not Applicable

Additional Education and Experience

In addition to the information already provided, list any volunteer activities, training or other experiences that you feel qualify you for the position for which you have applied.

Please attach your resume here.
Upload a .pdf, .doc, .docx, .rtf, .odt, .jpg, .png, .wps, or .txt file less than 2MB.

Certification/Authorization

Please read the following statements carefully.

Tahoe Forest Hospital District is an equal opportunity employer. The hospital district makes all employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, ancenstry, citizenship, age, marital status, military status or obligations, physical or mental disability, or mental condition.

I agree that my employment with Tahoe Forest Hospital District will be at-will. This means that either Tahoe Forest Hospital District or I may terminate the employment relationship at any time for any reason at all, with or without notice. This clause cannot be amended, changed, altered, or abolished except in writing signed by the hospital district Chief Executive Officer.

I agree that, if offered a position, I will be required to take and pass a physical examination before I will be allowed to commence work. Further, I understand that the information on this application is correct and that falsification or omission of any information on this application may be considered sufficient cause for immediate termination. I agree that, if employed, I will abide by and observe all policies, procedures, rules, and regulations established by Tahoe Forest Hospital District.

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* Signature:

* Date:

Please be patient while your application is processed.