Stone County Hospital

Online Application

EMPLOYMENT APPLICATION

Thank you for submitting your application for employment. It is our policy to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, or any other reason prohibited by law.

Your application will remain active for 60 calendar days from the date submitted. If you have not heard from us by that time, you may submit a new application. We will be happy to assist or accommodate you in completing your application and/or the application process. Please contact the facility if you wish to complete a paper application.

Name:

Address:

City:

State:

Zip:

Phone Number:

Alternate Phone Number:

Email Address:

Are you at least 18 years old?

Are you authorized to work in the U.S.?

Position applying for

Position Name

Salary Desired

Date Available for Employment

Position Status Desired: Full-timePart-timeTemporaryPRN

Shift desired: DaysNightsEvenings

You may be required to work day, night, weekend, or on-call shifts.

Have you ever been employed with any of the following facilities:

  • Leakesville Rehabilitation & Nursing Center
  • Stone County Nursing & Rehabilitation Center
  • Woodland Village Nursing Center
  • Stone County Hospital

Employment History

Upload Your Resume:

May we contact your current employer?
If no, please explain

Please complete employment history only if no resume is attached. List your employment history starting with your most recent job. Please attach a separate file for additional employment history listings.

Employer

Type of Business

Address

Phone number

Start Date

End Date

Supervisor's Name

Job Title

Job Duties


Employer

Type of Business

Address

Phone number

Start Date

End Date

Supervisor's Name

Job Title

Job Duties


Employer

Type of Business

Address

Phone number

Start Date

End Date

Supervisor's Name

Job Title

Job Duties

Skills

List any skills that you can apply to this job position and would be helpful to us in considering you for employment:

Education

High School:

Location:

Did you earn a Diploma:

Did you earn a GED:

College or Technical School Location Degree Received Graduation Date

License/Certification

Type State Registration Number Expiration Date

References - List (3) three Business References

Name Job Title Company Name Phone Number

Stone County Hospital is a tobacco-free workplace. You may be required to submit to a criminal background check and drug screen should you be the selected candidate.


I hereby affirm that the information on this application (and resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself. I understand that no management official other than the Chief Executive Officer of the employer has any authority to enter into agreement contrary to the foregoing or to make any oral assurance or promise of continued employment to me. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and resume, if any) to provide any relevant information that may be required to arrive at an employment decision.