Apply for FOOD SERVICE WORKER

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Summary
Title:	FOOD SERVICE WORKER
ID:	1079B
Location:	Clinton, AR
Department:	Food Services

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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Ozark Health Questionnaire

Employment Interest

Do you have experience in this Position and/or Department?

Yes No

Have you ever been employed by Ozark Health?

Yes No

If yes, state date left

If YES, are you a:

Previous Employee Current Employee

Do you have any relatives working for Ozark Health?

Yes No

If yes, who and what department are they in?

Which work status are you available for?

Full-time

Part-time

PRN

Date you are available to start work

Have you been employed under another name?

Yes No

If yes, state name

Shift or hours you can work?

Are you at least 18 years of age?

Yes No

ARE YOU EITHER A UNITED STATES CITIZEN OR AN ALIEN WHO HAS THE LEGAL RIGHT TO WORK IN THE JOB FOR WHICH YOU ARE APPLYING?

Yes No

Have you ever been convicted for a law violation?

Yes No

Ozark Health is a SMOKE and TOBACCO FREE employer. Smoking or tobacco product use (including e-cigarettes) is prohibited on campus (including parking lots, vehicles and adjacent properties). Smoke breaks are not permitted. Are you tobacco free?

Yes No

Education

Last High School

Name

City

State

Did you graduate or recieve a diploma?

Yes No

Jr. College, College or University

Name

City

State

Major

Years

Did you graduate or recieve a diploma?

Yes No

Jr. College, College or University

Name

City

State

Major

Years

Did you graduate or recieve a diploma?

Yes No

Technical or Vocational School

Name

City

State

Major

Years

Did you graduate or recieve a diploma?

Yes No

Experience

Give a complete record of all employment and reasons for periods unemployed during past 10 years. If you have NO work history, please leave section blank.

Start with most recent employment; give U.S. experience only. Do not leave periods of employment blank.

Employer 1

Please complete the following information regarding your last place of employment. If you have NO work history, please leave section blank.

From

Name

Street Address

City

State

Zip

Phone

Fax

Position Held

Supervisor Name

Reason for Leaving

Employer 2

Please complete the following information regarding your 2nd to last place of employment

From

Name

Street Address

City

State

Zip

Phone

Fax

Position Held

Supervisor Name

Reason for Leaving

Employer 3

Please complete the following information regarding your 3rd to last place of employment

From

Name

Street Address

City

State

Zip

Phone

Fax

Position Held

Supervisor Name

Reason for Leaving

Employer 4

Please complete the following information regarding your 4th to last place of employment

From

Name

Street Address

City

State

Zip

Phone

Fax

Position Held

Supervisor Name

Reason for Leaving

May we contact your present employer for references?

Yes No

REFERENCES

Give contact information of persons we may contact to verify your qualifications for this position including at least one supervisor

Reference 1

Name

Relationship

Phone Number

Organization

Reference 2

Name

Relationship

Phone Number

Organization

Reference 3

Name

Relationship

Phone Number

Organization

Professional Licenses, Registrations and/or Certifications

License, Registration and / or Certification #1

License/Reg/Cert 1 - Type

License/Reg/Cert 1 - State Issued

License/Reg/Cert 1 - Date

License/Reg/Cert 1 - Number

Are there any issues with this license?

Yes No

Has this license ever been revoked or put on suspension or probation?

Yes No

License, Registration and / or Certification #2

License/Reg/Cert 2 - Type

License/Reg/Cert 2 - State Issued

License/Reg/Cert 2 - Date

License/Reg/Cert 2 - Number

Are there any issues with this license?

Yes No

Has this license ever been revoked or put on suspension or probation?

Yes No

Affidavit

I understand that this Hospital has a policy which prohibits the possession and/or use of illegal or unauthorized drugs / tobacco / tobacco products on Hospital premises or which may affect the on-the-job performance of its employees. Pursuant to that policy, all job offers are conditioned on the satisfactory results of a drug / tobacco / tobacco product screen.

A positive result on the initial drug screen will require a further test be conducted using gas chromatography-mass spectrometry (GC-MS). No final employment decision will be made until the results of the GC-MS test have been received.

Results of the pre-employment screen will be confidential and will be maintained in a separate file in the Human Resources office. Results of the screen will be reviewed with me by the Vice President of Human Resources.

I understand that if I refuse the pre-employment drug / tobacco / tobacco product screen, I will cease to be considered for employment. I also understand that if I fail to satisfy the screening parameters, I will not be employed.

I hereby agree to this Hospital policy and consent to the requirements of the screen.

I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree that my employer shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers or omissions made by me in this questionnaire. I authorize the employers, companies, schools or people named above to give any information regarding my employment, together with any information they may have regarding me whether or not it is in their records. I hereby release said employers, companies, schools or persons from all liability for any damage, both legal and otherwise, for issuing this information. I also understand an offer of employment will be conditioned on results of a medical examination. In addition, if accepted for employment, I hereby agree to abide by the rules and policies of my employer.

Further, I understand that any employment is not for a stated period of time and may be terminated with or without cause, at any time, at the option of either myself or my employer.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER - A COPY OF THIS APPLICATION IS AVAILABLE TO YOU ON REQUEST.

My typed name below shall have the same force and effect as my written signature.

* Signature

Date

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