Application for Employment
Applicant Information














Placement Information











Education

High School







College







Graduate School



Vocational School / Other



Certifications / Licenses

Only required if you are applying for a position that requires licensure or certifications

License 1

License 2

License 3

License 4

Skills and Qualifications










Employment

Current Employer



Previous Employer



Previous Employer



References

Reference 1

Reference 2

Reference 3

Disclaimer

I understand that if I am employed, any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer's service whenever it is discovered.

I give the employer the right to contact and obtain information from all references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from all liability the employer and it's representatives for seeking, gathering and using such information and all other persons, corporations and organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only 60 days. At the conclusion of this time, if you have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer other than an authorized officer has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.


NOTE: Check entire form to be sure no questions have been omitted. If the question does not apply to you, please mark n/a (not applicable.)

Our Mission
The mission of Riverside Medical Center is to provide high quality health care services in a safe, compassionate and cost efficient environment to the residents of Washington Parish and the surrounding area.
Riverside Medical Center
Address:   1900 Main Street
                   Franklinton, Louisiana
                   70438-3688

Phone:      (985) 839-4431
Website by 5 Stones Media
Copyright 2017 by Riverside Medical Center
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