Grenada Lake Medical Center/Job Application

Job Description        PC#    PC#'s are found on the Job Listing page.

First Name   Middle Initial Last Name

Address City State   Zip Code

Social Security # Phone Number

Education           Name and Address of School        Years           Graduated     Date                Degree/Major

High School                

College                       

Graduate                     

Special Training           

Are you over the age of 18?    Yes    No

Ever applied for work at GLMC before?    Yes    No        If so, when 

Are you either a U. S. citizen or an alien who has the legal right to work in the job for which you are applying?

Yes    No

Please list relative and/or friends working here: 

Have you ever been convicted of a crime Yes    No    Who referred you to us? 

Work History- Give Dates; Company Name and Address; Supervisor's Name; Final Position; Salary; Reason for Leaving, and Describe Duties.

May we contact your current employer? Yes    No

Have you ever been displaced or discharged by a previous employer because of absenteeism, tardiness, or any other non-attendance or work?  Yes    No

Military Experience - From to Rank Achieved MOS