Apply Now Default Page General Information First Name Last Name What position are you applying for? Social Security Number Phone Address City State Zip Email If you are under 18, and it is required, can you furnish a work permit? YesNo If no, please explain Have you ever been employed at Hannibal Clinic before? YesNo If yes, give dates and positions. Are you legally eligible for employment in this country? YesNo Date Available to work? What is your desired salary range? Type of employment desired (check all that apply) Full-TimePart-TimeTemporarySeasonal Check hours available to work. Days (1st shift, M-F)Evenings (5:00 pm - 9:00 pm)Weekends (Sat-Sun)Pool Are you able to meet the attendance requirements of the position? YesNo Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? YesNo If yes, please provide date and details Driver's license number if driving is an essential function (Include number and state) Employment History Upload resume (.doc or .pdf file) or fill out employment history below Employment History (please include Employer Name, Address and phone number, dates you worked for the employer and whether or not the employer can be contacted as a reference) References Name Phone Number Relationship Number of Years Known Name Phone Number Relationship Number of Years Known Name Phone Number Number of Years Known Special/Related Training List any special training you've completed that may qualify you as being able to perform job-related functions in this position for which you are applying. Comment on any additional related experience(s) you may have had that may qualify you as being able to perform job-related functions in the position for which you are applying. License and Certification Information License/Certification Number (if applicable) Date Issued Expiration Date License/Certification Number (if applicable) Date Issued Expiration Date License/Certification Number (if applicable) Date Issued Expiration Date Educational Background Information (if job related) High School Number of Years Completed Did you graduate? YesNo College Number of Years Completed Major Degree Other Applicant Statement I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all reference (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I certify that I have read, fully understand and accept all terms of the foregoing Applicant StatementI do not agree with the above statement