Job Application 1 Personal Information2 Employment Information3 License/Certification4 Education5 Employer Information6 References7 Authorization, Release, and Resume Personal InformationName* First Last Home/Cell Phone*Email* Address* Street Address City State / Province / Region ZIP / Postal Code United States of AmericaCanada Country Are you under 16?YesNoIf hired, can you present evidence of your U.S. Citizenship or proof of your legal right to live and work in this country?YesNo Employment InformationWhat job position are you applying for?*How did you learn about this opening?Date AvailableMinimum Salary Requirements*Applying ForFull TimePart TimePRNTemporaryWhat shifts are you available to work?DaysEveningsWeekendsRotatingHours/days/shifts you CANNOT work?If hired, when could you begin? License/CertificationLicense/Certification License/Certification State License Number License Issued License Expired License Type Edit Delete There are no Licenses/Certifications. Add License/Certification Maximum number of licenses/certifications reached. Have you been previously employed at Bismarck Cancer Center? If yes, give job title and dates of employment and name (if different).Do you have any relatives currently employed at Bismarck Cancer Center? If yes, list names and relationshipsHave you ever been convicted of a crime? Are you currently named as defendant in a criminal proceeding for mistreatment, neglect or abuse of any person or a misappropriation of property? If yes, when, where and disposition of case.Have you ever been found guilty of abuse, neglect or mistreatment of persons or misappropriation of property by a court of law or in an administrative proceeding? If yes, when, where and disposition of case.Have you ever been convicted of any other felony or misdemeanor? If yes, please explain.Has your professional license or certification ever been subject to suspension, revocation or cancellation? If so, when, where and disposition of case.A criminal conviction record does not by itself constitute an absolute bar to employment. The nature of the conviction will be examined on a case-by-case basis, including subsequent rehabilitation and will be considered in relation to the responsibilities of the position sought in making each employment decision. EducationEducation Education Level Institution Name (aka School Name) Address Date Began Date End Did you Graduate? Number of Years Completed Degree Type Edit Delete There are no Education Levels. Add Education Level Maximum number of education levels reached. If your school records are under another name, please indicate that name here for reference requests. First Last Other scholastic honors, specialized training, education experiences or job skills that you feel would help us in determining your qualifications. Employer InformationEmployer Information Firm Telephone Firm's Address Your name while employed there for reference request Name of immediate supervisor Starting Title Starting Salary Date Began Present Title Present Salary Date Left Duties Reason for Leaving May we contact this employer for a reference? Edit Delete There are no Employers. Add Employer Maximum number of employers reached. ReferencesReferences Name of Reference Reference's Phone Reference's Address Relationship to Reference Edit Delete There are no References. Add Reference Maximum number of references reached. Authorization, Release, and ResumeAUTHORIZATION: I hereby certify that this application contains no willful misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge and belief. I am aware that should investigation at any time disclose any such misrepresentation of falsification, my application will be rejected and I may be removed from the job after appointment. I understand that under the Title VII of the Civil rights Act of 1964 and the North Dakota Human Rights Act, I cannot be discriminated against in employment, including consideration for promotion, for reason of race, color, religion, national origin, sex, or other employment related documents I may have been furnished are not contracts of employment; also, that any oral or written statements to the contrary are hereby expressly disavowed. The employer has my authorization to thoroughly investigate my work, criminal and personal history which is job-related. I certify that I will hold no person, corporation or organization liable for giving or receiving information in this investigation. I further understand that if I am employed, such employment is for an indefinite period of time, that either I or the Bismarck Cancer Center can terminate such employment at any time, and that the Bismarck Cancer Center can change wages, benefits and conditions at any time. (My typed name below shall have the same force and effect as my written signature.)Name First Last Date Date Format: MM slash DD slash YYYY RELEASE: Having made application for employment with Bismarck Cancer Center and desiring them to be informed as to my previous record and character, I hereby authorize Bismarck Cancer Center to investigate my past record and to ascertain any and all information which may concern my record and character, whether same is of record or not, and release my present and past employers, references, and all persons whomsoever from any damage because of furnishing said information. (My typed name below shall have the same force and effect as my written signature.) Name First Last Date Date Format: MM slash DD slash YYYY Should you receive an offer of employment with Bismarck Cancer Center, and accept such offer, prior to your employment date, a physical examination (at no charge to you) may be completed, or if you wish, you may choose a physician at your own cost. Your employment is contingent upon satisfactorily passing a physical examination prior to employment. In addition, our policy provides for an orientation period to allow Bismarck Cancer Center to review you and your adjustment to the new position. During this orientation period, you or your department managers have the freedom of terminating employment at Bismarck Cancer Center without notice. Bismarck Cancer Center operates continuously and you are expected to perform services in accordance with your job description and approved work schedule. Thank you for completing this application form and for your interest in employment with Bismarck Cancer Center. We assure you that your opportunity for employment will be based only on your merit, employment history and academic background.Upload Resume (PDF Only)Accepted file types: pdf.NameThis field is for validation purposes and should be left unchanged.