List current position first. Submit additional sheets if necessary.
List two references who are not relatives:
Please select one of the following:
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.