APPLICATION FOR EMPLOYMENT

Aurora Behavioral Health Care - Reno is an equal opportunity employer. The Company does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable state or federal civil rights laws
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Have you ever worked for Aurora Behavioral Health Care?
If YES, please identify where and when you worked:
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Have you previously applied at any Aurora Behavioral Health Care facility?
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PERSONAL INFORMATION

Are you related to, living with or an in intimate relationship with an employee currently working at this facility?
Are you able to perform the Essential Functions of the position(s) you are applying for, either with or without reasonable accommodations?
Do you have the legal right to work and be employed in the United States? (Proof of identity and legal authority to work in the U.S. is a condition of employment)
Are you at least 18 years of age? (Proof of age and work permits may be required prior to hiring)
Do you have a reliable means of transportation to and from work?

REFERRAL SOURCE


GENERAL INFORMATION

Have you ever been convicted of a crime other than a traffic violation? * 

Answer this question if you are applying for a position(s) with regular access to drugs/medications. Have you ever been arrested on charges of possession, sale, transport, cultivation or selling narcotics?

Answer this question if you are applying for a position(s) with regular access to patients. Have you ever been arrested for a sex offense for which registration as a sex offender may be required under Section 290 of the Penal Code?

EDUCATION

 NameGraduated?# Years AttendedCoursework/MajorG.P.A.
High School
Community College
Trade/Vocational School
College/University
Other

EMPLOYMENT/MILITARY SERVICE/VOLUNTEER AND WORK EXPERIENCE

Please identify all positions held in the past ten (10) years and all experience related to the position(s) you are applying for. Include periods of unemployment, self-employment, volunteer activities, school and/or military service.
May we contact your present employer?
May we contact your previous employers?

1. CURRENT OR MOST RECENT EXPERIENCE:

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Were you eligible for any type of additional pay?

2. NEXT MOST RECENT EXPERIENCE:

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Were you eligible for any type of additional pay?

3. NEXT MOST RECENT EXPERIENCE:

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Were you eligible for any type of additional pay?

4. NEXT MOST RECENT EXPERIENCE:

PROFESSIONAL LICENSE/CERTIFICATION/REGISTRATION

 TypeName on License/Certification/RegistrationState IssuedNumberExpiration Date (xx/xx/xx)
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CONDITIONAL OFFER OF EMPLOYMENT

Compliance with the hospital’s Drug-Free Workplace policy is a condition of employment and requires every employee to be free from alcohol and drug abuse. Each offer of employment is contingent upon successfully completing a urinalysis test for alcohol and drugs in accordance with hospital policy. This hospital will not hire any applicant who fails to pass the pre-employment alcohol and drug test. Continued employment is also contingent upon compliance with the hospital’s Drug-Free Workplace policy.
I have read, understand and agree to abide by these conditions of employment: *
I hereby certify that the information contained in this Application for Employment is true and correct to the best of my knowledge and agree to have any of the statements checked by the Company unless I have indicated to the contrary. I authorize the references listed above, as well as all other individuals with whom the Company contacts, to provide the Company any and all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Company as well as from any use or disclosure of such information by the Company or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this Application for Employment may result in my failure to receive an offer or, if I have already been hired, my immediate dismissal from employment.
 
In consideration of my employment, I agree to conform to the rules and standards of the Company. I further agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the Company. I understand that no employee or representative of the company, other than it’s President, has the authority to enter into any agreement for employment for any specific period of time, or to make any express or implied agreement contrary to the foregoing. Further the President of the Company may not alter the at-will nature of the employment relationship or enter into any employment agreement for a specific period of time unless the President and I both sign a written agreement that clearly and expressly specifies the intent to do so. I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of employment relationship and that there are no oral, written, or collateral agreements regarding this issue.
 
I also understand that all offers of employment are condition on the Company’s receipt of satisfactory responses to the reference requests, verification of previous employment, the provision of satisfactory proof of an applicant’s identity and legal authority to work in the United States and other items conducted during a background check. Offers of employment are also condition on the satisfactory completion of a post-offer medical examination.