Nursing Scholarship Essay

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Application For Employment
Montgomery County Memorial Hospital
2301 Eastern Ave
PO Box 498
Red Oak, IA 51566

We consider applications for all positions without regard to race, color, religion, creed, sex, national origin, disability, sexual orientation, citizenship status or any other legally protected status.|

Position| Date|
Last Name| First Name| Middle Name|
Address City State Zip Code| Telephone Number Social Security Number Home Cell| Best time to contact you at home is: ________:_________ AM or PM| Please circle your answer.|

If you are under 18 years of age, can you provide required proof of eligibility to work? Yes or No| Have you ever filed an application with us before? Yes or No| If Yes, give date: ______________________________| Have you ever been employed with us before? Yes or No| If Yes, give date: _______________________________| Do any of your friends or relatives, other than spouse, work here? Yes or No| Are you currently employed? Yes or No | May we contact your present employer? Yes or No| Are you prevented from lawfully becoming employed in this country because ofVisa or Immigration Status? Yes or No (Proof of citizenship or immigration status will be required upon employment.)| Date available for work _____/_____/_____ What is your desired salary range? _____________| Are you available ____ Full-Time (please indicate 1 2 3 shift) to work: ____ Part-Time (please indicate Mornings Afternoons Evenings) ____ Temporary (please indicate dates available ___/___/___-___/___/___| Are you currently on “lay-off” status and subject to recall? Yes or No| Can you travel if a job requires it? Yes or NoIf you drive for Montgomery County Memorial Hospital you are required to have the appropriate current and unrestricted license. You will be required to furnish proof of your driving record (copy of MVR from your auto insurance carrier) as part of your application and may be required to release your driving record annually thereafter.| Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under chapter 321 or equivalent provisions in this state or any other state? Yes or No| Education

| Name & Address of School| Course of Study| Number of Years Completed| Diploma Degree| Elementary School| | | | |
High School| | | | |
Undergraduate College| | | | |
Graduate Professional| | | | |
Other (Specify)| | | | |
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.| Describe any job-related training received in the United States military.| Other Qualifications:Summarize special job-related...
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