CMH Employment Application

Applicant please read: Thank you for your interest in employment. Citizens Memorial Healthcare is an equal opportunity employer. Your application will receive consideration without regard to race, sex national origin, religion, age, physical or mental impairment, or veteran status. Be assured that every application for employment is reviewed, even though every applicant is not granted an interview.

  • Please note that interviews are granted by appointment only. Be sure a telephone number is given where you can be reached or where a message may be left for you.
  • Your application is valid for a period of sixty (60) days. If you wish to be reconsidered for employment after sixty (60) days, you must submit another application form.
  • Citizens Memorial Healthcare discourages telephone job inquiries.
  • Citizens Memorial Healthcare and its affiliates are smoke-free environments.

*Indicates a required field

* Do you currently work for CMH?

Please make a selection.

 

If yes, enter your employee number:

* Position(s) Desired: Use <ctrl> key and mouse to select up to 5 positions.

Please select at least one item.
 

Personal Information

* First Name A value is required. * Home Phone
Middle Name Cell Phone -
* Last Name A value is required. Other Phone -
Suffix Other E-mail
Home E-mail

Mailing Address

Residence Address (if different)

* Address A value is required. Address
* City A value is required. City
* State Please select a state. State
* Zip Code A value is required. Zip Code

Education: Include High School, Colleges, and Technical Institutions attended

Educational Institution
Years Attended Major
Start Degree/Diploma
End Year Awarded GPA Invalid format, enter only numbers.
Educational Institution
Years Attended Major
Start Degree/Diploma
End Year Awarded GPA Invalid format - enter numbers only.
 
 
 
Educational Institution
Years Attended Major
Start Degree/Diploma
End Year Awarded GPA Invalid format - enter numbers only.
 
 
 
Educational Institution
Years Major
Start Degree/Diploma
End Year Awarded GPA Invalid format - enter numbers only.
 
 
 

Work Experience: Start with your current or last employment and work backwards, include periods of unemployment

 
Company Name
Dates Employed:
Address
Start
End
Job Title
Salary: Work Experience
Initial Numbers & decimal only.per Supervisor
Final Numbers & decimal only. Phone -
Reason Left
Description of Duties
Other Comments
Company Name
Dates Employed: Address
Start
End
Job Title
Salary: Work Experience
Initial Numbers & decimal only. per Supervisor
Final Numbers & decimal only. Phone - -
Reason Left
Description of Duties
Other Comments
Company Name
Dates Employed: Address
Start
End
Job Title
Salary: Work Experience
Initial Numbers & decimal only. per Supervisor
Final Numbers & decimal only. Phone - -
Reason Left
Description of Duties
Other Comments
Company Name
Dates Employed: Address
Start
End
Job Title
Salary: Work Experience
Initial Numbers & decimal only. per Supervisor
Final Numbers & decimal only. Phone - -
Reason Left
Description of Duties
Other Comments

Professional Licenses, Certifications and Skills (Use <ctrl> key and mouse to select more than one position)

Skills:
Computer Skills/Experience:
Languages Spoken:
Degrees:
Miscellaneous Skills:
Licenses & Certifications:
Additional Questions
PLEASE NOTE: (*) INDICATES A REQUIRED FIELD
* Social Security # A value is required.Invalid format.
Maiden Name (if applicable)
*Please enter your minimum salary requirements A value is required.
*Available Start Date A value is required.Invalid format.
*Have you ever been fired from a job?
Please make a selection.
If yes, please explain:
*Have you ever been given a disciplinary action?
Please make a selection.
If yes, please explain:
* Are you currently or have you ever been listed on a MO or any other state's employee disqualification list?
Please make a selection.
If yes, please explain:
* Do you have the legal right to reside and work in the United States?
Please make a selection.
* Have you ever had a conviction, plea of guilty or nolo contedere to a misdemeanor or felony charge which would include any suspended impositions of sentence, and suspended execution of sentence or any period of probation or parole?
Please make a selection.
If yes, please list the conviction(s), showing the offense and date:
The listing of convictions will not necessarily disqualify you from consideration for employment. Applicants must give their FULL criminal history. (Required by House Bill 1362).
* Have you ever been employed at CMH? Where? When? A value is required.
* Do you have any relatives that work for CMH? Who? Where? A value is required.
* Personal References - Please do not list relatives. References should be familiar with your work performance or educational background
Name: Relationship: Address: Phone Number:
A value is required. A value is required. A value is required. A value is required. - A value is required. - A value is required.
A value is required. A value is required. A value is required. A value is required. - A value is required. - A value is required.
A value is required. A value is required. A value is required. A value is required. - A value is required. - A value is required.
A value is required. A value is required. A value is required. A value is required. - A value is required. - A value is required.
PLEASE READ CAREFULLY I authorize investigation of all statements contained in this application, including drug testing, and release the employer, its agents, and employees from any liability resulting from such investigation. I understand misrepresentation or omission of facts is cause for dismissal. Further, I understand and agree that my employment shall be a probationary basis up to three months. I consent to taking a post-offer physical examination. Upon my termination, I authorize the release of reference information on my work. I understand receipt of this application in no way constitutes employment or any agreement to employ. I agree to abide by all rules and regulations in effect at the time of my employment or subsequently initiated. I also agree to work any shift in any department in case of emergency.
* Full Name A value is required.
* Date A value is required.Invalid format.
The Citizens Memorial Healthcare Guiding Principles are established to demonstrate a shared commitment to the highest level of excellence and professionalism throughout the organization.

At Citizens Memorial Healthcare, we are:
Positive
Respectful
Innovative
Dedicated
Empowered

In completing this application, I agree with these Guiding Principles and will strive to attain them throughout any employment. I know that I can make a difference. As an applicant, submitting this form below, I to, understand the mission and vision of Citizens Memorial Healthcare.

Additional Comments:
Resume - Type or Cut/Paste below:

Cover Letter - Type or Cut/Paste below:

*** Applying for a job at CMH is a two part process. Once you complete your application, you will be redirected to an online survey. Your application will not be fully processed in the system until this survey has been completed. ***

If you hit the Submit button and the form does not submit, scroll back up through the form and look for boxes that are red. Please make sure to fill in those boxes and then hit the submit button again.

Missouri Quality AwardStage 7 Award RecipientSBJ Dynamic Dozen Award Recipient SBJ Economic Impact Award Recipient Most Wired Award RecipientHospital 417-326-6000
Infocenter 417-328-6010 or 1-888-328-6010
infocenter@citizensmemorial.com
1500 N. Oakland, Bolivar, Missouri 65613