Contact
MENU

Application for Employment

We consider applicants for all positions, without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. INSTRUCTIONS: Complete all the necessary information. This application will be kept on file.
DESIRED EMPLOYMENT

















Yes
No
Yes
No
Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

EDUCATIONAL BACKGROUND































GENERAL

EMPLOYMENT HISTORY

(Start with your present or most recent job. Include any job-related military service assignments and volunteer activities.)





















































PROFESSIONAL REFERENCES

Please provide a list of professional references.

























APPLICANT'S STATEMENT (Please Read Carefully)

All information and answers to questions on this application are complete, true and correct to the best of my knowledge and belief. I understand that misrepresentation, falsification, or omission of any facts called for in this application may render it void and may result in my termination without liability whenever discovered.

I understand investigation of all statements contained in this application for employment may be necessary in arriving at an employment decision, including verification of professional license as required and background investigations which may include an examination of educational credentials, criminal convictions, and driving records as required by the responsibilities of the positions.

This application for employment shall be considered active for a period of time not to exceed ninety (90) days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time, and North Cypress Medical Center may discharge the employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document, or by conduct.

I also understand that I am not eligible for employment in any capacity at North Cypress Medical Center, if at any time I am "excluded" by the Office of Inspector General (OIG) from participation in Medicare, Medicaid, or other Federally- funded health care programs.

I have read the above statements. I understand them and agree to them. This application is the property of North Cypress Medical Center.

Yes I have read the above statements, understand them and agree to them.
No I have not read the statements, do not understand or do not agree to them.

Accreditation & Accolades