• APPLICATION FOR EMPLOYMENT

    APPLICATION FOR EMPLOYMENT

  • United Community Health Center

    1260 S. Campbell Rd., Bldg 2 Green Valley, AZ 85614

    Phone - 520-407-5600

    Fax – 520-625-8504

  • All applicants are considered without regard to race, color, gender, religion, national origin, age, marital or veteran status, mental or physical disability unrelated to job performance or any other legally protected status.

  • DATE*
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth*
     / /
  • Are you legally eligible for employment in the United States?*
  • Have you been convicted of a felony?*
  • Are you at least 18 years old?*
  • Do you have any obligation or other reasons which would limit your ability to travel or work overtime?*

  • POSITION INFORMATION

  • Employment status desired*
  • Have you ever applied with us before?*
  • Have you ever worked for our company before?*
  • Expiration date
     / /

  • EMPLOYMENT HISTORY (Most recent first)

  • Employment Type
  • May we contact?
  • Format: (000) 000-0000.
  • Employment Type
  • May we contact?
  • Format: (000) 000-0000.
  • Employment Type
  • May we contact?
  • Format: (000) 000-0000.
  • Employment Type
  • May we contact?
  • Format: (000) 000-0000.

  • EDUCATION

  • Rows

  • SKILLS

  • PC Type (check all that apply)

  • REFERENCES

  • Rows

  • CERTIFICATION & AUTHORIZATION

  • I hereby certify that all statements made in this application are true and correct to the best of my knowledge and belief. I understand that any misrepresentations or omissions of facts in this application are grounds for disqualification from further consideration or for dismissal from employment.

    I authorize the company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position.

    If employed, I agree to conform to the rules, regulations and policies of the company. I understand that I will be an employee “at will” and either the company or I may terminate my employment relationship at any time for any reason not in violation of law.

    I hereby acknowledge that I have read and fully understand the forgoing and seek employment under these conditions.

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