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Online Employment Application

Please complete & submit the following online application. Attaching a resume and cover letter is helpful, but not required. All applications will be reviewed by our Human Resources Department and responded to as quickly as possible.

We are an equal opportunity employer and value employees with enthusiasm and caring attitudes. If you have any questions about a position listing, your application or need further information please feel to contact the Human Resources Department during business hours at: 530-841-6200.

Note: only applications submitted with all required information - marked with a asterik (*) symbol - will be considered.

* Application Date: * Position Applying For:

Personal Information

* Full Name (First, Last & Middle):

* Street Address:    PO Box (if applicable):

* City:      *State:     *Zip:

* Primary phone Number:      Secondary Phone Number:

* Are you over 18 years of age? Yes No

* Can you, after employment, submit verification of your legal right to work in the United States?
Yes No

* Have you previously worked for Fairchild Medical Center or Siskiyou General Hospital?
Yes No

* Shift Preferred: Day PM Night

* Days Preferred:

* Type of work: Full-time Part-time

If your application is considered favorably, when would you be available for work?

* Have you been convicted of a felony within the last 7 years? Yes No
   Conviction will not necessarily disqualify applicant from the job applied for.

* Do you have any physical condition or handicap which may limit your ability to perform the job applied for?
Yes No

If yes, please explain what can be done to accommodate your limitation:
List any relatives working for Fairchild Medical Center (include relationship):

Education

* High School: * Highest grade completed: 9 10 11 12

College Education (List any Degree(s) received):

Describe any other training or education:

Employment Information

List other name(s) under which employment may be verified:

Complete the following information by listing your present or last job first. Include any job-related Military Service assignments and volunteer activities. If you need additional space, please attach a Microsoft Word document, PDF or resume.

* Employer #1: * Dates Employed:

* Address (include city & state):

* Job Title: Supervisor:

* Describe Work Performed:

* Reason for leaving:

* Employer #2: * Dates Employed:

* Address (include city & state):

* Job Title: Supervisor:

* Describe Work Performed:

* Reason for leaving:

Employer #3: Dates Employed:

Address (include city & state):

Job Title: Supervisor:

Describe Work Performed:

Reason for leaving:

Please identify and explain all periods of unemployment in excess of one month during the past 10 years:
Dates: Reason for Unemployment:
Dates: Reason for Unemployment:
Dates: Reason for Unemployment:
Dates: Reason for Unemployment:

Questions / Comments:

For security purposes, we no longer accept attached cover letters or resumes. Please fax this type of information to our Human Resources Department: 530-841-0193

Applicant's Statement

I authorize Fairchild Medical Center to inquire as to my record with any or all of my former employers with no liability arising therefrom. I certify that answers given herein are true and complete to the best of my knowledge and I understand the making of any false statements will be sufficient cause for my dismissal. Offers of employment are also conditioned on the satisfactory completion of a pre-employment background check and post-offer medical examination. In consideration of my employment, I agree to conform to the rules and regulations of Fairchild Medical Center as set forth in the Human Resource Policies and Employee Handbook and my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Hospital or myself.

* By checking the following box, I certify that I have read and understand the above statement and submit my application under this agreement.