Auburn Hospital Employment Application

Please select the position you are interested in applying for:

ACH General ApplicationAdministrative Director of Emergency Services - (FT) Auburn Community HospitalAMMS Billing Manager - FT - Auburn Community HospitalAssistant Nurse Manager - Med/Surg (FT) Auburn Community HospitalAssistant Nurse Manager – Behavioral Health (FT) Auburn Community HospitalBehavioral Health Unit Therapist - FT - Auburn Community HospitalBreast Care Patient Navigator/RNCertified Central Sterile Technician - (Full time) Auburn Community HospitalCertified Nursing Assistants (FT and PT) Finger Lakes Center for LivingCoder - (Full Time) Auburn Community HospitalCT Technologist - Radiology (FT) Auburn Community HospitalEchocardiography TechnicianECU Clerk/Tech (PT) Auburn Community HospitalFood Service/Dietary Positions (Part-Time) Auburn Community HospitalHospitalist (NP or PA) Auburn Community HospitalHousekeeping Attendant (FT 3p-11p) Auburn Community HospitalLicensed Practical Nurses (FT and PT) Finger Lakes Center for LivingLPN/RN Float – (Full Time) – Auburn Memorial Medical ServicesLPN/RN Medical Office – (Full Time) – Auburn Memorial Medical ServicesLPN/RN OB/GYN office (Full Time) – Auburn Memorial Medical ServicesLPNs (Full and Part-Time) Auburn Community HospitalMedical Technologists (FT) Auburn Community Hospital- $10,000 sign-on bonusNurse Aide trainee - Auburn Community Hospital/Finger Lakes Center for LivingNurse Manager/Med/SurgNurse Manager/Peri Operative ServicesNurse Practitioner or Physician Assistant - Critical Care Unit (FT evening and nights) Auburn Community HospitalNursing Supervisor - Acute (FT) Auburn Community HospitalNursing Supervisor - Extended Care FT 3p-11p Finger Lakes Center For Living- 10k Sign on BonusOperating Room Technician – OR (FT) Auburn Community HospitalPatient Access Clerk (Part time) - Auburn Community HospitalPatient Care Assistants (FT, PT) - Auburn Community HospitalPhysician Assistant / Family Nurse Practitioner - AMMS - Urgent CareRadiologic Technologist (Full time) - Auburn Community HospitalRegistered Nurse – Behavioral Health (FT, PT, & PD) Auburn Community HospitalRegistered Nurse – Critical Care (FT and PT) Auburn Community HospitalRegistered Nurse – Emergency Room (FT and PT) Auburn Community HospitalRegistered Nurse – Float Pool (FT and PT) Auburn Community HospitalRegistered Nurse – Interventional Radiology (FT) Auburn Community HospitalRegistered Nurse – Med/Surg Unit (FT and PT) Auburn Community HospitalRegistered Nurse – One Day Surgery/PACU (FT) Auburn Community HospitalRegistered Nurse – OR (FT & PT) Auburn Community HospitalRegistered Nurses - OB-GYN (FT and PT) Auburn Community HospitalRespiratory Therapists (FT and PT) Auburn Community HospitalRN Case Manager - (FT) Auburn Community HospitalRN Clinical Leader - Emergency Department (FT) Auburn Community HospitalRN Clinical Leader/Day Surgery/PACURural Track Family Practice Medical Director - (FT) Auburn Community HospitalRural Track Family Practice Residency Site Program Director - (FT) Auburn Community HospitalSecurity Guard (Full time and Part time) Auburn Community HospitalSocial Work Discharge Planner - (FT) - Auburn Community HospitalSocial Worker (Per diem) Auburn Community HospitalStaff Pharmacist & Oncology Pharmacist (Full time) - Auburn Community HospitalUnit Secretary (FT, PT, per diem) Auburn Community HospitalUrgent Care - Physician Assistant / Family Nurse Practitioner (Full Time) - Auburn Community HospitalUtilization Review Registered Nurse (Case Manager

Applicant Personal Information

Disclaimer: Positions listed below may not be available at the time of application, however, all applicants will be placed into a pool and considered when job availability opens up.

First Name (required)

Middle Name

Last Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Home Phone (required)

Cell Phone

Work Phone

E-Mail Address (required)

Have you ever been employed at Auburn Community Hospital, Auburn Memorial Medical Services (AMMS, PC) or the Finger Lakes Center For Living? (required)
YesNo

If so, when?

How did you learn of this position?
Employee ReferralWalk InMonster.comCareer BuilderJob FairTemp AgencyCollege RelationsOpen HouseExternshipAdCommunity or Other AgencyOther

Additional Information

If ad, friend, relative, job fair or other, specify

Employment History

Date Available for Work (required)

Pay Expected

Type of Employment Desired
No preferenceFull-timePart-timePRNWeekendOvernightTemporarySummerPer Diem

Are you willing to work weekends? (required)
YesNo

Are you willing to work holidays? (required)
YesNo

Are you legally authorized to work in the US? (required)
YesNo

Are you 18 years of age or older? (required)
YesNo

Have you applied for employment with our organization within the past two years? (required)
YesNo

Do you have any employment commitments with any other employer, including any form of self-employment or contract work, which you expect to keep even if you are hired by our company? (required)
YesNo

Have you ever been known by a different name? (required)
YesNo

Can you perform the essential functions of the job for which you are applying with or without reasonable accommodations? (required)
YesNo

Enter Name & Location of all High Schools, Vocational Schools, Business Schools, Colleges, and Related Military Courses attended.

High School

Name

City

State

Zip

Course/Study

# of Years of High School Completed

Graduate?
—Please choose an option—YesNo

College

Name

City

State

Zip

Course/Study

# of Years of College Completed

Graduate?
—Please choose an option—YesNo

Degree

Other Trade, Business, Night or Correspondence School

Name

City

State

Zip

Course/Study

Zip

Graduate?
—Please choose an option—YesNo

Degree

Typing
YesNo

Typing Words Per Minute

Medical Terminology Knowledge
YesNo

Medical Coding
YesNo

List Computer Program Knowledge

Are there any other special experiences or skills you feel would especially qualify you for the position?

Branch of Service

From

To

Rank at Discharge

Date of Final Discharge

Describe your duties & any special training which may be related to the position(s) for which you are applying

Type

Organization

State Issued

Number

Expiration

Job Opportunity

Reference 1

Name

Relationship

Telephone

Reference 2

Name

Relationship

Telephone

Reference 3

Name

Relationship

Telephone

Employer 1

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

Employer 2

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

Employer 3

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

If you wish, you can upload a resume/cover letter below.

Gender
MaleFemaleOtherPrefer Not to Say

Veteran Status
YesNoPrefer Not to Say

Have you been a resident of New York for the past two consecutive years? (required)
YesNo

Have you ever been convicted in any state of the United States of a felony or misdemeanor? (required)
YesNo

Are there any criminal charges pending against you anywhere? (required)
YesNo

Have you ever been convicted of an offense (misdemeanor or felony) other than a minor traffic violation? (Driving under the influence [DUI] and Driving while intoxicated [DWI] convictions are not minor and must be reported.)
YesNo

Have you ever been found guilty of a criminal offense?
YesNo

Have you ever been imprisoned or jailed in a criminal proceeding?
YesNo

A "yes" to any questions above does not automatically keep you from being hired. If you answered "yes" to any questions you must fully explain.

Your omission or falsification of any criminal history, or any disclosure required by this form, is a cause for dismissal from employment or consideration for employment.

Examples of a criminal offense: Assault/battery, auto theft, disorderly conduct, domestic violence, DUI/DWI, fraud ( welfare/food stamps) loitering, prostitution/solicitation, robbery, shoplifting, theft (grand/petty), trespassing, worthless checks. Note: This is not a complete list and is intended to provide examples only. You must list all convictions including juvenile incidents and those in which adjudication was withheld and/or records were sealed/expunged.

I verify that this information is true, and that I have not been convicted of any crime that would disqualify me from the position(s) for which I am applying. I hereby authorize company to request, obtain and examine any and all records that may relate to my arrest, conviction and/or imprisonment at any time for any felony or misdemeanor and I expressly release and hold harmless any party providing the aforementioned criminal information requested by company. (required)

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