Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.
Give your full employment record, starting with your current or most recent employment
List all professional licenses, registrations, and certifications:
Please provide three references (not relatives).
I certify that the information I provided in this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of facts in this application disqualifies me from further consideration, or, if I am employed, is sufficient cause for dismissal regardless of when the misrepresentation or omission of fact is discovered
I authorize investigation of all statements contained in this application and understand that I may be required to provide verification (diploma, license, transcripts, type tests, etc.) of information contained in this application. I authorize any and all persons, companies, or agencies to release to Bear Lake Memorial Hospital any and all information they may have, which is relevant to the application process. I also release all such parties from any liability that may result from furnishing information to Bear Lake Memorial Hospital.
I understand that if I am employed with Bear Lake Memorial Hospital, my employment will be at-will. As such it can be terminated by me or by Bear Lake Memorial Hospital with or without advance notice, at any time, and for any reason not prohibited by law.
I understand that any employment offer is contingent upon the following: (1) producing documents establishing my eligibility to work in the United States; (2) satisfactorily passing the pre-employment drug screen, employee health evaluation (if required), establishing that I am able to perform the essential functions of the position; the completion of a criminal background and reference checks; and (3) complying with Bear Lake Memorial’s pre-employment application procedures.
I have not been excluded, suspended or debarred from participating or providing services in any Medicare/Medicaid program or any other federally funded health care program, nor am I being investigated in any matter that could lead to my exclusion from a Medicare/Medicaid program or any other federally funded health care program.
I acknowledge that I have read the certification and agreement, and agree to abide by its terms.