L.A. Downtown Medical Center (L.A.D.M.C.) is an Equal Opportunity Employer.

We consider applicants for all positions on the basis of qualifications and without regard to race, color, religion, gender identity, national origin, age, marital status, veteran status, disability or handicap, sexual orientation, familial/genetic information or any other legally protected status.

This application will be considered active for a period of six months from the date of its completion. If you wish to be considered for employment after that time, you must personally submit a new application. Incomplete application forms (even when accompanied by a résumé) will not be considered. You must fill in your own application. Omissions or falsifications may result in ineligibility for employment or immediate dismissal if employed.

Attestation

Important: READ THIS CAREFULLY BEFORE SUBMITTING THIS APPLICATION.
I certify that the answers given by me on this application are true, correct, and complete. I agree that any misstatement or pertinent omission mady by me in this application may result in my rejection for employment, or if hired, may subsequently subject me to dismissal. Moreover, I understand that offers of employment may be conditioned upon my passing a physical examination (compliant with Title 22), background check and/or drug test.

Application for Employment

Full Name

Position(s) Applied For

Your E-mail Address

Home Address

Previous Home Address

Home Telephone Number

Mobile Telephone Number

Date Available to Work

Select All Shifts You Wish To Work Select All Shifts You Wish To Work Full Time Part Time Per Diem (P.R.N.) Days Nights Weekends Holidays Other

Are You Currently Working? Are You Currently Working? Yes No

Are You Currently 18 Years of Age? Are You Currently 18 Years of Age? Yes No

Are you lawfully eligible to be employed in the United States? Proof of identity and/or eligibility status is required upon employment. Are you lawfully eligible to be employed in the United States? Proof of identity and/or eligibility status is required upon employment. Yes No

License Type and Number, State, Expiration Date

Credential Type and Number, State, Expiration Date

Indicate Your Current Certifications Indicate Your Current Certifications C.P.R. / B.L.S. A.C.L.S. P.A.L.S. C.P.I. Los Angeles City Fire Card I.V. Therapy/Blood Withdrawal

Previous employee of L.A.D.M.C. as either staff or contract/agency employee? Previous employee of L.A.D.M.C. as either staff or contract/agency employee? Yes No

Dates of Prior L.A.D.M.C. Employment

Reason for previously leaving L.A.D.M.C.:

Other Name(s) You Have Worked Under / Alias(es)

Do you have friends or family working at L.A.D.M.C.? Do you have friends or family working at L.A.D.M.C.? Yes No

List your friends or family who work at L.A.D.M.C.

How did you hear about L.A.D.M.C.?

Have you ever been dismissed or asked to resign from a job? Have you ever been dismissed or asked to resign from a job? Yes No

Explain being dismissed or being asked to resign.

High School Name, Location, and Telephone Number

High School Course of Study

Did you receive your high school diploma? Did you receive your high school diploma? Yes No

Trade/Vocational School Name, Location, and Telephone Number

Trade/Vocational School Course of Study

Did you receive your trade/vocational school certificate/diploma/degree? Did you receive your trade/vocational school certificate/diploma/degree? Yes No

College Name, Location, and Telephone Number

College Course of Study

Did you receive your college degree? Did you receive your college degree? Yes No

Graduate School Name, Location, and Telephone Number

Graduate Course of Study

List any academic, professional, trade or job-related organizations that you are a member.

General Computer Knowledge

Experience with an Electronic Health Record

Ability to use Microsoft Word

Ability to use an E-mail Client (Outlook)

Ability to use Excel Spreadsheets

Office Equipment: Fax, Copier, Telephones, etc.

Describe any skills or aptitudes that you feel would qualify you for a position with L.A.D.M.C.

Business Reference #1 Name, Occupation, Company Name, Telephone

Business Reference #2 Name, Occupation, Company Name, Telephone

Business Reference #3 Name, Occupation, Company Name, Telephone

May we contact these business references? May we contact these business references? Yes No

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