Smith County Memorial Hospital Employee Application

Full Name*

Last name, First name, Middle initial

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Which position(s) are you applying to?*

Rate of pay expected

Are you available to work:*

Check all that apply

Full-time
Part-time
PRN
Temporary

Shift preference:*

Check all that apply

Days
Evenings
Nights
Weekdays
Weekends

Were you previously employed at SCMH or SCFP?*

Yes
No

Date employment ended

SCMH is committed to infection prevention. As such, several immunizations are required as a condition of employment. Are you immunized or willing to be immunized against infectious diseases such as influenza and COVID-19?*

Yes
No

Please provide your education and work history.*

I would like to upload a resume and cover letter.
I would prefer to complete my work and education history summary online.

Cover letter and Resume*

Please upload a letter of interest and a current resume for your desired position. References may be requested at a later point in the application process.

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 50 MB, Max. files: 2.

List any relatives or friends currently employed by SCMH or SCFP:

How did you hear about this position?*

If you were referred by SCMH staff, who should we thank?*

Education

Please fill in your educational history below.

Institution #1*

Name Location Years Attended Did you graduate?

Did you graduate?*

Yes
No

List diploma or degree*

Other Education

Name Location Course of Study Years Attended

Did you graduate?

Yes
No

List diploma or degree

Employment History

Please submit your employment history using the form fields below. List all present and past positions beginning with the most recent.

Company name*

Company address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company phone*

Start date*

End date*

Current salary*

May we contact this employer

Yes
No

Company name

Company address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company phone

Start date

End date

Ending salary

Name of supervisor

May we contact this employer

Yes
No

Company name

Company address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company phone

Start date

End date

Ending salary

Name of supervisor

May we contact this employer

Yes
No