Bethany St. Joseph Corporation Employment Application

About the Job...

Select the facility/services that you are interested in applying for:*

Hold down the Ctrl key to select more then one location.

Which City do you prefer to work in?

For what position are you applying?*

2nd Position Choice

Date you are available to start work:*

Type of Employment Desired: (Hours listed as a two-week period)*

Hidden

Type of Employment desired:

Full-Time (75 plus hours a pay period)
Full-time (60-75 hours a pay period)
Part-Time (40-60 hours a pay period)
Part-time (20-40 hours a pay period)
As Needed/On-Call (less then 20 hours)

Shift Preference(s)*

Days
PMs
Nights
Combo/Rotating Shifts

List any salary requirements below.

Where did you first learn about the position opening (what brought you to the BSJ website):*

List other source where you learned of position

Name of person who referred you

Have you worked for this Corporation (currently or in the past)?*

Yes
No

Location*

Date*

Do you have a family member or committed relationship with anyone in this Corporation?*

Yes
No

Such as a spouse, domestic partner, child, sibling, step-parent, in-laws, etc.

If yes, please identify the person, relationship, and building?*

Would you like to upload a resume or manually enter education & employment information?

Your Education...

High School Attended:

Number of High School Years Completed:*

One
Two
Three
Four

Have you received a diploma?*

Yes
No
G.E.D.

College/Vocational School

School Name	Location	Major	Number of Years Completed	Degree Earned:

You may add more than one by clicking the plus (+) sign to the right.

List Professional Licenses or Certifications:

Type	State Issued	Registration #	Date

You may add more than one by clicking the plus (+) sign to the right.

Tell us about any special training, skills, and/or military experience pertinent to the position for which you are applying:

Your Employment History and References...

Please provide the following information of your most recent three (3) employers and one (1) personal reference.

Are you currently employed?*

Yes
No

Employer 1*

Place of Employment	Position	Month/Year Hired	Month/Year Ended	Ending Wage

Do you grant permission to contact this employer?

Yes
No

Employer 1 Phone Number

Employer 1 Address

Street Address City State ZIP Code

During the interview process, it is expected that you provide your prior employer's address and telephone number in order to conduct reference checks. By providing it now, you will not be asked to provide it in the future.

Summarize Nature of Work and Job Responsibilities

Reason for leaving Employer 1

Employer 2

Place of Employment	Position	Month/Year Hired	Month/Year Ended	Ending Wage

Do you grant permission to contact this employer?

Yes
No

Employer 2 Phone Number

Employer 2 Address

Same as previous

Street Address City State / Province / Region ZIP / Postal Code

Summarize Nature of Work and Job Responsibilities

Reason for leaving Employer 2

Employer 3

Place of Employment	Position	Month/Year Hired	Month/Year Ended	Ending Wage

Do you grant permission to contact this employer?

Yes
No

Employer 3 Phone Number

Employer 3 Address

Street Address City State / Province / Region ZIP / Postal Code

Summarize Nature of Work and Job Responsibilities

Reason for leaving Employer 3

Employer 4

Place of Employment	Position	Month/Year Hired	Month/Year Ended	Ending Wage

Do you grant permission to contact this employer?

Yes
No

Employer 4 Phone Number

Employer 4 Address

Street Address City State / Province / Region ZIP / Postal Code

Summarize Nature of Work and Job Responsibilities

Reason for leaving Employer 4

Do you have additional employment that is related to the job you are applying for that you have not included?*

Yes
No

Please list additional employment. Include place of employment, job title, dates of employment and a brief discription of your job duties.

Personal Reference

Personal Reference Name*

Relation

Personal Reference Address

Street Address Address Line 2 City State ZIP Code

Personal Reference Phone Number*

Personal Reference Email

Resume/Cover Letter Attachment

Please attach your resume and/or cover letter here.

Drop files here or

Max. file size: 256 MB.