Employment Application

Please submit your job application by filling out the form below, or download Wesbury’s Employment Application.

The information collected on the following page will be used for the sole purpose of determining your employment suitability. It will not be sold or otherwise distributed in any form.

To visit Wesbury’s current employment openings please visit our: Job Opportunities section.

Contact Information





* Are you a US citizen?
* Are you legally authorized to work in the United States?
* Are you below the age of 18?

If so, do you have work papers?

* Have you ever been convicted of a criminal offense?






* Are you currently on probation?

* Do you have any relatives or friends working here?
If yes:









Position
* Please check the jobs for which you wish to be considered:


Are you able to occasionally work weekends and holidays?
What shifts are you willing to work?

I'm willing to work full-time.
I'm willing to work part-time.

Were you previously employed by Wesbury United Methodist Community?

If yes, when, in what department?







Registration License

Professional registration and/or licensure for RN, LPN or CNA:





General Information
Are you able to perform the essential functions of the position for which you are applying, with or without accommodation?
Do you have reliable transportation?
Military Service


Dates of Service




Skills

Education

High School





Course of Study




Vocation/Technical School





Course of Study




College














Nursing School












GED or other






Other Training


Employment History

List your present or most recent employer first. Account for complete work history below.










Dates Employed



Personal References









Additional Info



PLEASE READ AND SIGN THE FOLLOWING:

APPLICANT PLEASE READ CAREFULLY BEFORE SIGNING.

1. I hereby certify that the information I have provided in the employment application is true and complete to the best of my knowledge. I understand that if I am hired, the discovery of any false information provided or any relevant information omitted (no matter when discovered) shall result in the termination of my employment.

2. I authorize and instruct Wesbury to make whatever inquiries it deems necessary of any person or organization who is not a consumer reporting agency to verify any of the information I have provided in this application and to determine my qualifications and abilities.

3. In exchange for Wesburyʼs agreement to receive, process and consider my application for employment, I hereby release Wesbury and any and all persons or organizations contacted by Wesbury from any and all claims or causes of action arising out of Wesburyʼs verification of the information I have provided in this application and/or its determination of my qualifications and abilities.

4. I understand that if an offer of employment is made to me it shall be contingent upon my completion of a post-employment offer physical assessment to the satisfaction of Wesbury. I hereby consent to undergo physical examination which may include any and all tests and procedures determined by Wesbury to be helpful in evaluating my suitability for employment, including but not limited to blood tests, urinalysis, X-rays, controlled substance and/or alcohol testing, etc.

SIGN IN THE GRAY BOX BELOW WITH YOUR MOUSE CURSOR (or finger if using a touch-screen)