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Employment Application

Please note the position you are applying for. Can request to be kept on file.
Contact Information
Availability Information
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Education Information
License/Certification Information
To be completed by registereed, licensed, or certified applicants
Employment Record
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Employer 3
Reference 1
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Reference 3
Additional Information
Acceptable formats: Word Documents (.doc, .docx) / Acrobat files (.pdf) / Text documents (.txt, .rtf). Maximum file size 4MB.
Files must be less than 4 MB.
Allowed file types: txt rtf pdf doc docx.

By submitting this online form I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of information in connection with my application and/or interview will be sufficient cause, in and of itself, for rejection or dismissal whenever discovered.

I understand and agree that any offer of employment is dependent upon satisfactory completion of a pre-employment investigation which includes but is not limited to education and work history verification, reference checks and any investigation required by local, state, or federal laws.

I understand that if I am hired by Stevens Community Medical Center or any of its affiliates or subsidiaries, my employment will be for an indefinite period of time and will be “at will”, which means that either I or Stevens Community Medical Center may terminate the employment relationship at any time and for any or no reason. I further understand that, if hired, my at-will employment status may only be changed in a written contract signed by the President of Stevens Community Medical Center or the President’s authorized representative, and that no representative of Stevens Community Medical Center has the authority to make any oral promise to me concerning my employment. Finally, I also understand that while Stevens Community Medical Center supports current policies and benefits, it retains the right to change them at any time, with or without notice.

Stevens Community Medical Center is an Equal Employment Opportunity Employer committed to providing a safe, healthy and productive work environment and supports a smoke free, alcohol and drug-free environment.

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