Job Application

Full Time

Available Position(s)

Job Application

Job Description

Apply in person at: Hospital Information Desk 317 McWilliams Ave, Camden, AL 36726
Email to: [email protected]
For more information call: (334) 682-4131

Download Application (PDF)

Application for Employment

First Name

Last Name

Please leave this field empty.

Last 4 Digits of SS#

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Email Address

Personal Information

Are you 18 years of age or older?

How did you hear about J. Paul Jones employment opportunities?

Are you on the OIG or OMIG Exclusion lists?

If yes, please give details:

Position Applied For:

Shift Preferred:

What date will you be available to begin?

Would you be interested in Temporary Employment?

Rate of pay expected?

Have you ever been employed at J. Paul Jones Hospital?

If yes, provide dates:

Education

High School / GED

Name of School

Address

Did you graduate?

Diploma or Degree

College

Name of School

Location

Did you graduate?

Diploma or Degree

Other School

Name of School

Location

Graduated?

Diploma or Degree

Computer Skills

MS Office

Outlook

Other

Professional Licenses and/or Certificates

Type:

State Issued:

1. Name and Relationship

1. Telephone/Email

2. Name and Relationship

2. Telephone/Email

Please select one of the following:

Options:

I authorize Verification of all Information Given and not request salary informationI Authorize Verification of all Information except from Present Employer and not request salary information (Note: Current Employer will be called after candidate has given notice at current position)

Are you able to perform the essential, job related functions of the position for which you are applying with or without reasonable accommodations?

Describe any accommodations necessary:

Options:

Have you been convicted of a crime and/or released from confinement following a conviction for any criminal offense?

If yes, give date, place, and nature of each such conviction:

Are you presently charged with any violation of the law?

If yes, give date, place, and nature of each such event:

Equal Employment Opportunity

In all employment decisions including but not limited to recruitment, hiring, compensation, training, promotion, upgrading, demotion, downgrading, transfer, layoff, and termination, and all other terms and conditions of employment, it is the policy of J. Paul Jones Hospital to provide equal opportunity to persons regardless of race, religion, age, gender, disability or any other classification in accordance with federal, state and local statutes, regulations and ordinances.

Full Legal Name

Date