Menu Close

Application for Employment

We are an equal opportunity employer: this organization is committed to the policy of equal opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job-related experience and other qualifications will be considered without illegal discrimination on grounds of race, color, religion, sex, national origin, age or status as qualified handicapped or as a protected veteran defined by law. All information provided in this application will be treated confidentially and will be used to help assure the best use of your abilities if you are employed by us. If you feel that any of the following questions are discriminatory in nature, do not answer such questions.

Employment Application

About You

High School
Other (College, Technical, Trade)
Other (College, Technical, Trade)


Start with present or most recent employer, list all periods of employment including time spent in Military Service. If you need more space than this, please use the box provided at the bottom of this page. Complete addresses and phone numbers are required.

Employer #1
Employer #2
Employer #3
Employer #4

Personal & Medical Information

Personal References
List three persons, not relatives, clergy, or previous supervisors, with complete address and phone numbers who have know you at least two years.
Reference #1
Reference #2
Reference #3

Read carefully before clicking the 'Apply' button:
To the best of my knowledge and belief, all statements on this application are complete and correct. I fully understand that any false or omitted statements will be sufficient cause for cancellation of the application and/or separation from Barnesville Hospital's services, if employed. Furthermore, I give Barnesville Hospital full investigative power as to my character, including criminal records, credit and financial status, or any other information deemed necessary for my application at Barnesville Hospital.

This application becomes inactive after 90 days unless renewed.