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Application
Complete the form below to express your interest in employment with Wabash General Hospital.
Personal Information
First Name:
MI:
Last Name:
Address:
City:
State:
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Tennessee
Texas
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Washington
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Zip Code:
Please list any previous names:
Phone:
E-mail:
Are you at least 18:
Yes
No
Are you willing to take the required Drug Tests?:
Yes
No
Have you been employed here before?:
Yes
No
Do you have a valid drivers license?:
Yes
No
Have you ever been debarred or excluded from participation in Medicare, Medicaid or any other federal or state funded health care program?:
Yes
No
Please provide an explanation and current status:
Position
Position desired:
General Application
Business Office - Patient Access Clerk (PRN)
Environmental Services - Environmental Services Aide (2- PRN)
Environmental Services - Environmental Services Aide (FT) *$500 Retention Bonus Eligible*
Environmental Services - Environmental Services Aide (FT) Float *$500 Retention Bonus Eligible*
Environmental Services - Environmental Services Aide (PT)
Family Medicine - Family Medicine Physician
Human Resources - Temporary Door Screener
Information Technology - Clinical Informatics Nurse
Information Technology - IT Application Specialist
Laboratory - Phlebotomist Clerk (FT)
MCU - Staff Registered Nurse- MCU (FT) *$2,000 Sign-on
Med/Surg - Staff Registered Nurse (FT)
Multiple Clinics - Certified Medical Assistant (FT) *$2,000 Sign-On Bonus*
Nutrition Services - Culinary Chef (PRN)
Orthopaedics - CMA/Nurse- PRN
Orthopaedics - Scribe (FT)
Outreach Clinic - Athletic Trainer (FT) *$2,000 sign-on
Outreach Clinic - Athletic Trainer (PRN)
Plant Operations - Plant Operations Technician (FT)
Primary Care - Physician Office Receptionist (2-PRN)
Primary Care-Oak - Physician Office Scribe (PT)
Quality - Patient Experience Coordinator, Nurse
Radiology - Radiology Technologist (PRN)
Rehab - Physical Therapy Assistant (PRN)
Rehab Services - Cardiac Rehabilitation Registered Nurse
Rehab Services - Speech-Language Pathologist (PRN)
Respiratory Therapy - Respiratory Therapist (FT)
Respiratory Therapy - Respiratory Therapist (PRN)
Senior Enrichment Center - Licensed Primary Therapist/Social Worker (SEC)
Sleep - Sleep Lab Technician
Surgery - Certified Surgical Technician * $2,000 Sign-On
WPC Clinic/Specialty - Office Nurse/CMA (FT)
WPC Grayville - Office Nurse/CMA (FT)
Desired Salary:
Type of position you are interested In. :
Education
School or Program:
Years Completed:
Degree or Accreditation earned:
Major or Subject:
School or Program:
Years Completed:
Degree or Accreditation earned:
Major or Subject:
School or Program:
Years Completed:
Degree or Accreditation earned:
Major or Subject:
Employment History
Employer 1:
Employer Address:
Employer Phone Number:
Job Start Date:
Job End Date:
Job Title:
Responsibilities:
Reason for leaving:
Employer 2:
Employer Phone Number:
Employer Address:
Job Start Date:
Job End Date:
Job Title:
Responsibilities:
Reason for leaving:
Employer 3:
Employer Phone Number:
Employer Address:
Job Start Date:
Job End Date:
Job Title:
Responsibilities:
Reason for leaving:
Please explain any gaps in your employment, other than those due to personal illness, injury or disability.:
If not addressed in previous answers, if you have been fired or asked to resign from a job, please provide details:
Upload your Resume:
Release
I certify that I have read, fully understand and accept all terms of this Applicant Statement and Release.:
Yes
No
Signature
Applicant Signature:
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