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Employment Application

In considering your application for employment, the facility may conduct a detailed and thorough investigation which may include but is not limited to a criminal record check, interviews or inquiries of prior employers, coworkers, acquaintances, relatives or friends.

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
PRN Emergency Dept. RN
Wellness Coordinator/LPN
Resident Care Assistant-PRN
RN/LPN Med Surg/Tele
PRN Physical Therapist
PRN Med/Surg/Tele RN
PRN Medical Technologist/ Medical Laboratory Technician
Critical Care Tech (C.N.A., MA, LPN, or EMT)
PRN Occupational Therapist
PRN Respiratory Therapist
Physical Therapist Assistant
Emergency RN
PRN Imaging Technologist
PRN Speech Therapist
House Supervisor, RN
C.N.A. - Med Surg/Tele
Patient Account Specialist- Remote
Revenue Cycle Analyst- Remote
Surgical Technician- Certified Surgical Technician, RN, or LPN with Scrub Experience
PRN Patient Account Payment Analyst- Remote
Surgery Director
Pain Clinic C.N.A. or Medical Assistant
Physical Therapist

Would You Consider Working:

Shift Preference
Have you ever been convicted of, or plead guilty to, a crime other than misdemeanor traffic violations?
(You are not required to disclose any SEALED or EXPUNGED criminal records.)
Have you ever been involved in the substantiated abuse or neglect of children or adults under the laws of this or any other state of the united states?
Have you been sanctioned, cited, reported, or excluded from participation in medicare, medicaid, or any other healthcare related law or regulation?

If your answer is Yes to any of the above, you will not be automatically disqualified from employment consideration, except as required by state or federal law.

Education / Skills

High School



Professional License 1

Professional License 2

Professional Certification 1

Professional Certification 2

Previous Experience
Provide Information Regarding Previous Employment Beginning With Most Recent Employer.
May We Contact your Current Employer
Do Not Complete Unless Requested
At least 3 References Who Are Not Relatives
Standards of Behavior

Thank you for your interest in joining our hospital team!

We have a strong mission of providing excellence in health care and promoting lifelong wellness in the communities we serve. As hospital staff, we have a wonderful opportunity to practice excellence in customer service. We take pride in meeting and surpassing the expectations of patients, families, physicians, and each other every day. This means we support and treat each other with a high level of respect, dignity, and service.

With this in mind, our staff have developed standards of behavior to guide us in achieving and maintaining service excellence. Our goal is to choose staff that will be able to follow and exemplify these standards.

We have attached a copy of the standards of behavior. By signing the application you are agreeing to follow the standards of behavior and understand that this is a condition of employment at Hillsboro Area Hospital.

Download the Standards of Behavior Document.


Carefully Read This Section Prior To Providing Signature Below

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date.

I understand that employment may be conditioned upon successfully passing a medical examination and that I may be required to satisfactorily complete a drug screening as a condition of employment.

I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information.

I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of this facility and notarized. I have read and agree to follow the attached Standard of Behavior