Thank you for your interest in employment at McBride Orthopedic Hospital. This Hospital is an equal opportunity employer and complies with federal and state laws prohibiting discrimination based on race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap.

We assure you this application will be treated fairly and confidentially.

What Position and Shift are you applying for:
Referral Source: Newspaper Ad      Job Fair      State Employment Agency
  Contract Labor Agency      School Referal      Employee Referal
  Other   
Name: Last:      First:      Middle Initial:  
Address Line 1:
Address Line 2:
City:          State:      Zip:
Telephone: ( )  -
Mobile/Pager: ( )  -
Email:
Drivers License #:    State:
Preferred Salary: $    
Have you been employed here before?     Yes     No    If yes, give dates:
Are you available to work      Full-Time      Part-Time      PRN
If hired, on what date would you be available to start work?     Month: Day: Year:
Are you legally elligible to work in the United States?   Yes   No
Are you over 18?   Yes   No
Have you ever been convicted of, plead guilty to, or pled "no contest" or "nolo contender" to a felony or misdemeanor?   Yes   No
(Note: Convictions will not necessarily bar you from employment, but are reviewed as related to the relevancy of the job for which you have applied.)
If yes, please explain:
 
 
Educational Background
High School:
   Name:      City:      State:    GPA:
   Did you graduate? Yes   No     Dates of Attendance: From:      To:
 
College:
   Name:      City:      State:    GPA:
   Did you graduate? Yes   No     Dates of Attendance: From:      To:
   Course of Study:      Degree Received:
 
Advanced Degree:
   Name:      City:      State:    GPA:
   Did you graduate? Yes   No     Dates of Attendance: From:      To:
   Course of Study:      Degree Received:
 
Other Course of Study:
   Name:      City:      State:    GPA:
   Did you graduate? Yes   No     Dates of Attendance: From:      To:
   Course of Study:     Degree Received:
 
Additional Education, Training, Professional Activities, Accomplishments, Skills, Licensure, or Certificates:
 
Employment History
Please provide accurate, complete full-time and part-time employment information. Start with present or most recent employer and list last four places of employment, including military service and volunteer activities. Exclude organizations which indicate race, color, religion, sex or national origin.
 
Company Name:
Job Title:
Address:
City:     State:     Zip:
Supervisor:
Duties:
Telephone: ( )  -
Dates of Employment: From:      To:
Salary: Beginning:      Ending:
Reason for leaving:
May we Contact? Yes      No     If no, Reason:
 
Company Name:
Job Title:
Address:
City:     State:     Zip:
Supervisor:
Duties:
Telephone: ( )  -
Dates of Employment: From:      To:
Salary: Beginning:      Ending:
Reason for leaving:
May we Contact? Yes      No     If no, Reason:
 
Company Name:
Job Title:
Address:
City:     State:     Zip:
Supervisor:
Duties:
Telephone: ( )  -
Dates of Employment: From:      To:
Salary: Beginning:      Ending:
Reason for leaving:
May we Contact? Yes      No     If no, Reason:
 
Company Name:
Job Title:
Address:
City:     State:     Zip:
Supervisor:
Duties:
Telephone: ( )  -
Dates of Employment: From:      To:
Salary: Beginning:      Ending:
Reason for leaving:
May we Contact? Yes      No     If no, Reason:
 
 
 
It is sometimes difficult for applicants to adequately communicate their background and qualifications in the limited spaces provided. Please use this space to summarize any additional information you believe necessary to describe your full qualifications.
 
 
PLEASE READ CAREFULLY
APPLICANT'S CERTIFICATION AND AGREEMENT

Pre-Employment Drug Screen: I understand that if I am accepted for employment at McBride Orthopedic Hospital, I must submit to a pre-employment drug screen. Failure to pass the drug screening test will result in the conditional offer of employment being withdrawn.

Pre-Employment Physical: In accordance with the Oklahoma State Department of Health Standards and Regulations and to assure that all employees have the physical qualifications necessary to perform essential functions of the job in accordance with the American Disabilities Act (ADA) without posting a direct threat to the health or safety of others and are free of active communicable disease, I understand that a pre-employment physical examination is required if I am accepted for employment at McBride Orthopedic Hospital, Inc.

Statement of Certification: By signing this application I certify that all the information provided on this form is true and complete to the best of my knowledge. I understand that any misrepresentation, falsification or omission herein, or during any other correspondence, discussions, or interviews will be considered justification for refusal of employment or subsequent termination should I become employed. I understand that all information provided during the application process is subject to investigation and verification and I authorize McBride Orthopedic Hospital, Inc. to make all necessary and appropriate investigations allowable by law to verify the information provided herein. I understand that this application is not and is not intended to be any kind of employment contract or agreement. I further understand that in the event of employment, my employment is at-will and at the discretion of McBride Orthopedic Hospital, Inc. and has no specified term; it can be terminated at-will, with or without notice, at any time, for any or no reason, at the option of either myself or McBride Clinic Orthopedic Hospital, Inc.
 
 
BY SUBMITTING THIS FORM YOU AGREE TO THE APPLICANT'S CERTIFICATION AND AGREEMENT