Employment Application Apply Now "*" indicates required fields General InformationFull Name* First Middle Last Current Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Main Phone*Other PhoneEmail Address* Are you legally entitled to work in the United States?* Yes No Have you ever worked for RLMC?* Yes No If yes, when and what was the previous position held? Did anyone from RLMC refer you?* Yes No If yes, who? Do you have any relatives that work for RLMC?* Yes No If yes, who? PositionPosition applying for* Salary Desired*Date available to start work or length of notice needed to give current employer:* Are you able to perform the essential functions of the job you are applying for, with, or without reasonable accommodations?* Yes No Will Accept:* Full-time Part-time Casual/Temporary Previous EmploymentCurrent Employer* Supervisor Phone*Job Title* From (Mo/Yr) To (Mo/Yr)* Hours Per WeekEmployer Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code May we contact this employer? Yes No Specific DutiesAttach additional documentation if needed using the upload button at the bottom.Reason for LeavingWould you like to add a second Employer?* Yes No Employer 2* Employer 2 - Supervisor Employer 2 - Phone*Employer 2 - Job Title* Employer 2 - Employed From (Mo/Yr) To (Mo/Yr)* Employer 2 - Hours Per WeekEmployer 2 Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code May we contact this employer? Yes No Employer 2 - Specific DutiesAttach additional documentation if needed using the upload button at the bottom.Employer 2 - Reason for LeavingWould you like to add a third Employer?* Yes No Employer 3* Employer 3 - Supervisor Employer 3 - Phone*Employer 3 - Job Title* Employer 3 - Employed From (Mo/Yr) To (Mo/Yr)* Employer 3 - Hours Per WeekEmployer 3 Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 3 - May we contact this employer? Yes No Employer 3 - Specific DutiesAttach additional documentation if needed using the upload button at the bottom.Employer 3 - Reason for LeavingEducationHigh School Graduate or Passed General Education* Yes No School/Location College, Technical, or Business School Name Location Years AttendedDegree Major Would you like to list a second College, Technical or Business School?* Yes No School 2 - College, Technical, or Business School Name School 2 - Location School 2 - Years AttendedSchool 2 - Degree School 2 - Major Would you like to list a third College, Technical or Business School?* Yes No School 3 - College, Technical, or Business School Name School 3 - Location School 3 - Years AttendedSchool 3 - Degree School 3 - Major Special Skills, Licenses, and CertificationsList skills, licenses, and certifications belowVeteran InformationBranch of Service Date of Entry Date of Discharge Professional ReferencesMust be current or previous employer and consist of manager, supervisor, or Human Resource personnel.Reference 1 - Company Reference 1 - Name Reference 1 - Relationship Reference 1 - PhoneReference 1 - Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Would you like to enter a second Professional Reference?* Yes No Reference 2 - Company Reference 2 - Name Reference 2 - Relationship Reference 2 - PhoneReference 2 - Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Would you like to enter a third Professional Reference?* Yes No Reference 3 - Company Reference 3 - Name Reference 3 - Relationship Reference 3 - PhoneReference 3 - Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EQUAL OPPORTUNITY EMPLOYER Rainy Lake Medical Center is an equal opportunity employer. It is policy that all individuals are entitled to equal employment opportunity regardless of race, color, religion, gender, national origin, age or disability, as required by state and federal law. All appropriate steps are taken to ensure equal opportunity in employment with respect to all personnel actions, including, but not limited to: recruiting, hiring, compensation, benefits, education and promotion/advancement opportunities EMPLOYMENT APPLICATION DISCLAIMER AND ACKNOWLEDGEMENT I certify that the information contained in this application and any supporting document(s) provided is true and complete to the best of my knowledge. I authorize any of the persons or organizations listed in my application to give all information concerning my previous employment, education, or other information with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information. I understand that my employment is contingent upon verification of information provided; passing the required reference and background check; and required drug and alcohol testing. I understand that my employment is contingent upon proof of identity and verification of eligibility for employment in the United States, in accordance with Immigration Reform Act of 1986. I understand that falsifying information is grounds for refusal to hire, or for discharge should I be hired. I understand that any employment offered to me is terminable at any time, with or without cause and without advance notice. Upload Resume or Additional Information Drop files here or Select files Max. file size: 16 MB, Max. files: 3. Applicant Signature* Today's Date* CommentsThis field is for validation purposes and should be left unchanged.