Employment Application

Appleton Area Health (AAH) is an equal employment opportunity employer dedicated to a policy of nondiscrimination in employment based upon an individual’s race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, familial status, disability, sexual orientation, age, or other characteristics protected by law. In reading and answering the following questions, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences, or discrimination based upon any non-job-related information. This application will be given consideration, but its receipt does not imply that the applicant will be interviewed or employed. If you need an accommodation to participate in the application process, please contact Human Resources at (320) 289-8529.

Employment Application

Personal Information

Position Information

Are you seeking:(Required)
Shifts Desired:*(Required)
Date Available:*(Required)
Days Available:*(Required)
Have you been employed with AAH before?*(Required)
Are you at least 16 years of age?*(Required)
Hire is subject to verification that you are of minimum legal age

Education

Did you graduate?
Last year completed:
Did you graduate?
Last year completed:
Did you graduate?
Last year completed:
Did you graduate?
Last year completed:

Job Requirements / Specifications

References

Please list three references other than past supervisors or family members:

Employment History

Status:
May we contact this employer?
Status:
May we contact this employer?
Status:
May we contact this employer?
Status:
May we contact this employer?

Other Information

Please list volunteer, unpaid work experience, and any other additional information which may relate to the position for which you are applying. Please do not include religious, ethnic, or political affiliations.

I understand and agree that any offer of employment is contingent on completing and passing a physical examination based on the physical demands of the job for which I am applying.

I authorize investigation of all statements contained in this application and understand that misinformation or omission of information not given on my employment application form and during the physical examination is sufficient cause for discharge if I am employed

I understand that nothing contained in this employment application or in the granting of an interview or in any policies, procedures, or handbooks I might receive, is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing and signed by an authorized representative of the company. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason and the company retains a similar right regarding the discontinuation of my employment.

I understand that a criminal background check will be performed, education credits and previous employment history will be verified prior to employment; signing this application is authorization to do so.

Each employee is expected to follow …

The Values that make us SHINE!

Service - our actions speak louder than words

Honesty - demonstrated by what we say and do

Integrity - know and do what is right

Nurturing - trusted and compassionate care

Empowering - promote positivity and teamwork

I have read and understand the Values that make us SHINE. If employed at Appleton Area Health, I agree to comply with and practice the values as outlined. Non-compliance of any of these values will result in disciplinary action per AAH policies up to and including termination.