Employment Application

PERSONAL INFORMATION

Incomplete information could disqualify you from further consideration. Please complete all fields.

EMPLOYMENT HISTORY

Include up to five (5) years of employment history, including periods of unemployment, starting with the most recent and working backward in time. Incomplete information could disqualify you from further consideration.

Employer #1

REFERENCES

Give the names of three persons not related to you, whom you have known at least three (3) years.

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Bunkie General Hospital to hire me. If I am hired, I understand that either Bunkie General Hospital or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Bunkie General Hospital has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Bunkie General Hospital true and complete information on this application. No requested information has been concealed. I authorize Bunkie General Hospital to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.