Online Employment Application

We offer a competitive salary and benefits package, advancement opportunities and a warm, friendly work environment. We serve our patients, customers, volunteers and fellow employees with the highest ethical and professional conduct. Our warm, friendly, family of employees is what makes Hi-Desert Medical Center such a great place to work. View a list of positions available or fill out a job application on-line.

Application for Employment
Hi-Desert Medical Center affords equal employment opportunity regardless of sex, age, race, color, religious creed, national origin, ancestry, marital status, physical or mental disability or sexual orientation.

All areas of the application must be filled out completely and accurately.  Please fill in the required information directly on the application and do not indicate "see resume".  Please print clearly in blue or black ink. 

If you have any questions about completing this application, it is important to ask the Hi-Desert medical representative who has been assisting you.
Date *
Choose Date
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PERSONAL DATA
First Name *
Middle Initial *
Last Name *
Present Address *
City *
State *
Zip *
Phone *
E-mail address *
Mailing Street Address (if different from above):
Mailing City (if different from above):
Mailing Zip Code (if different from above):
Other names under which you have worked
Are you over 18 years of age? *
If under 18, can you, after employment, submit a work permit? *
Can you, after employment, submit proof of age? *
Have you ever been convicted of a crime (misdemeanor or felony)? *
Conviction may not necessarily disqualify an applicant from employment.
If yes, please list all convictions, giving dates, locations, and disposition of your case(s) below.
List of convictions
Have you ever been convicted of a crime as defined in 42 U.S.C. 1320a-7b? *
If yes, please explain
Alternative contact person:
First Name *
Last Name *
Street Address *
City *
State *
Zipcode *
Phone Number *

ALL APPLICANTS ARE SUBJECT TO PRE-EMPLOYMENT DRUG SCREENING PROCEDURES
POSITION DESIRED
First Choice *
Second Choice
Specify: *
Days And Hours
Shift Preferred *

Will you work weekends? *
Will you rotate shifts? *
Are you able to perform the essential functions of the position for which you are applying with or without accommodation?
Answer *
Have you ever applied for employment at HDMC? *
If yes: Month
Were You previously employed by HDMC? *
If yes, reason for leaving:
Dates you were previously employed from:
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Do you have relatives employed by HDMC? *
Note:  Related Employees may not work in the same dept., same shift.
If an offer is extended, when would you be available for work? *
How did you become aware of the position for which you are applying? *
EDUCATION & TRAINING
School Name
Address
City
State
Zip Code
Did you Graduate? *
Course or major
Diploma/Degree
School Name 2
Address
City
State
Zip Code
Did you Graduate? *
Course or major 2
Diploma/Degree
School Name 3
Address
City
State
Zip Code
Did you Graduate? *
Course or major 3
Diploma/Degree
Professional license/Certification No.
Type of License
Place of issue
Expiration Date
Professional license/Certification No.
Type of License
Place of issue
Expiration Date 2
Professional license/Certification No.
Type of License
Place of issue
Expiration Date 3
Please list job related organizations, clubs, associations, to which you belong. (You may omit those which indicate race, religious creed, color, etc.)
List Organizations
What personal, technical or professional skills do you bring to us, which you feel will benefit the medical center?
Personal Skills
List three persons willing to provide professional/and or character references: (Do Not List Relatives)
First Name *
Last Name *
Reference Occupation *
Street Address *
City
State *
Zip Code *
Home Phone Number. *
Work Phone Number *
First Name *
Last Name *
Reference Occupation *
Street Address *
City *
State *
Zip Code *
Home Phone Number. *
Work Phone Number *
First Name *
Last Name *
Reference Occupation *
Street Address *
City *
State *
Zip Code *
Home Phone Number. *
Work Phone Number *
GOALS AND INTERESTS

Please tell us about your goals, interests, or any comments you may have relative to this application
List goals, interests or comments
EMPLOYMENT HISTORY (Resume may not be substituted for a completed application)
Are you presently employed? *
May we contact your present employer? *
List below your work experience for the past 10 years, beginning with the most recent, you must provide phone numbers for employers.  (Use additional sheet for additional employment information.)

Give reason for gaps in employment.
Dates of Employment
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Starting Earnings
Ending Earnings
Employer Name
Street Address
City
State
Zip
Phone
Supervisor
Number Supervised
Job Title & Duties
Reason for leaving
Dates of Employment
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Starting Earnings 2
Ending Earnings
Employer Name
Street Address
City
State
Zip
Phone
Supervisor
Number Supervised
Job Title & Duties
Reason for leaving
Dates of Employment
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Starting Earnings
Ending Earnings
Employer Name
Street Address
City
State
Zip
Phone
Supervisor
Number Supervised
Job Title & Duties
Reason for leaving
Dates of Employment
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Starting Earnings
Ending Earnings
Employer Name
Street Address
City
State
Zip
Phone
Supervisor
Number Supervised
Job Title & Duties
Reason for leaving
Dates of Employment
From:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
To:
Choose Date/Time
Sun. Mon. Tue. Wed. Thu. Fri. Sat.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
:
Starting Earnings
Ending Earnings
Employer Name
Street Address
City
State
Zip
Phone
Supervisor
Number Supervised
Job Title & Duties
Reason for leaving
PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW
I certify that I have answered all questions truthfully and have not withheld information relative to my application. I understand that any falsification, misrepresentation, or omission as well as any misleading statements or omission of the application information, attachments and supporting documents generally will result in denial of employment or immediate termination, if discovered after hire.
I Agree *
I authorize Hi-Desert Medical Center to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment, and further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I release Hi-Desert Medical Center, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities, arising out of or in any way related to such investigation or disclosure.
I Agree *
If hired, I recognize the rules and policies of Hi-Desert Medical Center, I understand that my employment and compensation can be terminated at any time, with or without cause, and with or without Notice, at the option of Hi-Desert Medical Center or myself. I understand that the Administration of Hi-Desert Medical Center has the authority to create any other terms of employment and/or to enter into any employment contract and that all such contracts must be in writing and signed by both parties.  However, I also understand that unless otherwise stated in an employment contract, the company may change, withdraw or interpret other policies (including wages, hours, and working conditions) as it deems appropriate.
I Agree *
I understand and acknowledge that I will be required to submit the examining facility and to a physical examination, including drug test.  Additionally, I hereby authorize the release of the results of such an examination to Hi-Desert Medical Center for their use in evaluating my suitability for employment.  Further, I release  the examining facility and Hi-Desert Medical Center from any and all liability, and from any damage that may result from the release of such information.
I Agree *
I also understand that all offers of employment are conditioned on the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States, as well as the satisfactory completion of a post-offer medical examination.
I Agree *
By clicking on I Agree this indicates that I have read and understand the importance of supplying accurate information on the application.  I am also aware of the possibility that an offer of employment being withdrawn if any of the information is not correct.
I Agree *
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