Shriners Hospitals For Children Application For Employment
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4Shriners Hospitals for Children Application for Employment
Instructions:
Please complete all sections of this form. Incomplete or unsigned forms will not be considered.
Please print and use ink. Sign page 3 and page 4. Applications are considered for a 90-day period only. If you
wish to be considered after 90 days from the date of application, please reapply. Do not fill in shaded areas.
Personal Information
Last
First
Middle
Name
Street
Address
City
State
Zip
Social Security Number
Phone: Home
Work
Cell
Type of Employment Desired
Position(s)
1
2
If offered a job, when could you begin?
Date:________________
Availability
What is the approximate salary you expect to be paid?
$____________per__________
Salary
Weekends
Schedule/Shift
Day
Evening
Nights
Rotate
Part-time
PRN Pool
Full-time
Temporary
Education and Licensure
Dates requested in this section will be used only to verify the accuracy of education and licensure information.
Please use an additional sheet if you attended multiple schools.
Name
City
State
High School
Did you graduate or have a GED?
Yes
No
Final Grade Point Average (GPA):___________
Name
City
State
Technical
Did you graduate?
Yes
No
GPA:_________
Degree or Area of Study:
Name
City
State
College
Did you graduate?
Yes
No
GPA:_________
Degree:
Year:
Major:
Undergraduate
Name
City
State
College
Did you graduate?
Yes
No
GPA:_________
Degree:
Year:
Major:
Postgraduate
Type
State
Year
Verified by:
License
Is your license current?
Yes
No
Number
Type
State
Year
Verified by:
License
Is your license current?
Yes
No
Number
Type
Certification
Is your certificate current?
Yes
No
Verified by:
Type
Certification
Is your certificate current?
Yes
No
Verified by:
Shriners Hospitals for Children is an Equal Opportunity Employer and maintains a Drug Free Workplace.
Before you can work for Shriners Hospitals for Children, you will be required to pass a drug/alcohol screening
Form 4029
Page 1
1/29/2016
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Parent category: Business