Silver Cross Hospital

The way you should be treated.™

  • Emergency Department Wait Times Updated Live

    Wait times are approximate
    and updated every 30 minutes

  • 1900 Silver Cross Blvd.
    New Lenox, Illinois
    Map and directions
    0-15 min
    Silver Cross
  • 12701 West 143rd Street
    Homer Glen, Illinois
    Map and directions
    0-15 min
    Homer Glen

Employment Application

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 1 year.
Job Posting Select Posting to Apply for: 
General
Personal Information
First Name*:
Middle Name:
Last Name*:
Home Phone*:
Contact Phone:
Best Time to Contact You:
Email Address:
Previous Names (Maiden Name) you have had:
Present Address
Street*:
City*:
State*:
Zip Code*:
Permanent Address
Street:
City:
State:
Zip Code:
High School
School:
City:
State:
Diploma:
If not graduated, years completed?:
Undergrad School
School:
City:
State:
Diploma:
Degree:
Area of Study:
If not graduated, years completed?:
Grad School
School:
City:
State
Diploma:
Degree:
Area of Study:
If not graduated, years completed?:
Other School
School:
City:
State:
Diploma:
Degree:
Area of Study:
If not graduated, years completed?:
Employment Information
Position Applied For:
Date You Can Start:
Desired Salary ($):
Are you applying for?:
 Full-Time
 Part-Time
 Registry
Can you work:
 Days
 Evenings
 Nights
 Weekends
Available:
 Weekends/Holidays
 Rotating Shifts
 On-Call
 Any Shift
Not Available:
How were you referred to this facility?:
Please answer all of the following questions.
1.
Are you at least 18 years of age?*
2.
Are you legally eligible to work in the United States?*
3.
Have you worked at this facility before?*
 
If yes, when?*
 
4.
Do you have any relatives or friends employed by this facility?
 
If yes, please list their name, department, and relationship
 
5.
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?*
 
If yes, which states(s), and please explain*
 
6.
Have you been sanctioned, cited, reported, or excluded from participation in medicare, medicaid, or any other healthcare related law or regulation?*
 
If yes, please explain*
 
7.
Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?*
 
If yes, which state(s), and explain (you are not required to disclose any SEALED or EXPUNGED criminal records)*
 
Employer
May we contact your present employer?
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (1)
May we contact this employer?
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (2)
May we contact this employer?
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer (3)
May we contact this employer?
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay Upon Leaving:
Supervisor:
Duties:
Reason For Leaving:
Gaps in Employment
Please explain any gaps in employment longer than 3 months:
Additional Information About You
Professional Licenses:
Currently Licensed
Eligible for License
Currently Registered
Eligiblie for Registration
License Type:
License Number:
State:
Date (mm/yyyy):
Has your license or registration ever been suspended, revoked or placed on probation?
 
If so, please explain
 
Currently Licensed
Eligible for License
Currently Registered
Eligiblie for Registration
License Type:
License Number:
State:
Date (mm/yyyy):
Has your license or registration ever been suspended, revoked or placed on probation?
 
If so, please explain
 
Professional Certifications:
Currently Certified
Eligible for Certification
Certification Type:
State:
Date (mm/yyyy):
Currently Certified
Eligible for Certification
Certification Type:
State:
Date (mm/yyyy):

Please list at least 3 references that are not relatives.

Reference (1)
Name:
Company:
Title:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (2)
Name:
Company:
Title:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (3)
Name:
Company:
Title:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference (4)
Name:
Company:
Title:
Address:
Telephone:
Relationship:
Years Acquainted:
Resume (Text Version)
 
Copy and Paste a text version of your resume here.
 
Upload File
 
Attach a file to your application submission
 
Applicant's Certification Agreement
1.
The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained herein.
2.
The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3.
If hired, my employment is voluntary, meaning that either party can terminate employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4.
Any employment offer is contingent upon my providing proof of identity and eligibility to work in the country of employ.
5.
I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6.
I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
 
Signature
 
Type Name in Signature Box*:
 
 
Today's Date: 2012-05-17 03:16:22 CDT

News

  • Silver Cross Hospital Wins National Marketing Awards
    Read more...
  • Silver Cross Hospital Supports Lincoln-Way Student Intern Program
    Read more...
  • Clear the Confusion on Supplements
    Read more...

Social Media

«
»

Thomson Reuters Top 100 Hospitals

Located at 1900 Silver Cross Blvd., New Lenox, IL 60451   Main Phone (815) 300-1100

© Copyright 2012 Silver Cross Hospital. All Rights Reserved.