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Thank you for your interest in joining the Coffey Health System team. 
To learn about our employee benefits program, click here.

 

How did you learn of this job opening?*

Are you able to work:*

Indicate your preferred place of employment. Mark all that apply.*


Name


Race / Ethnicity
Gender*


Address


Phone Number


General
Are you over 18 years of age?
Have you ever been employed by Coffey Health System?*
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Please include full name.
Do you have any relatives employed by Coffey Health System?
Are you currently employed?*
If yes, may we contact your present employer?*
Do you have a current and valid Kansas state drivers license?*
Have you been convicted of a crime which resulted in being listed by a state or federal agency as disbarred, excluded or otherwise ineligible?*
Have you ever been convicted of a crime other than a traffic violation?*
Have you ever been discharged from a job?*
Is there any reason why you would be unable to safely perform any of the duties of the positions for which you applied with or without reasonable accommodations?*
Do you have the legal right to live and work in the United States?*


Education


Undergraduate / College


Graduate / Professional


Additional Information
Specialized Skills


Employment Experience
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Professional References



Applicant's Statement
The facts set forth in my application for employment are true and complete. False statements, answers or omissions on this application shall be sufficient cause for non-consideration for employment or for dismissal after employment. I also recognize that my employment is based on receipt of satisfactory information from former employers and references, and my ability to pass pre-employment screenings. I herein authorize the administration for this institution to investigate, without liability, the information supplied by me in this application for employment including academic, occupational, health, police, and governmental records. I also authorize listed employers and references, without liability, to make full response to any inquiries by the administration of this institution in connection with this application for employment. Further, if employed, I agree to work the hours, days and shifts as scheduled. I will share weekend and holiday coverage. I will work in another department if requested to do so. I understand and agree that the terms, conditions, compensations, benefits, hours, schedule, and duration of my employment (whether set forth in the Employee Handbook or not) may be determined, changed or modified from the time at the will of my employer without limitation or condition. I FURTHER CERTIFY THAT I HAVE READ THE FOREGOING PARAGRAPH AND KNOWINGLY MAKE THIS AUTHORIZATION BY SETTING FORTH MY SIGNATURE.
This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Agree / Disagree*
(By checking "I AGREE", I verify the above "APPLICATION'S STATEMENT" is true.)
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Have you been excluded from participation in Medicaid/Medicare because of fraud conviction?
 
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