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Careers > Employment Application Form

Employment Application Form

Apllication for Employment

Humboldt General Hospital is an equal opportunity employer. No question on this application is asked for the purpose of excluding any applicant’s consideration for employment because of race, color, religion, sex, age, national origin, sexual orientation, veteran’s status or disability. ANY APPLICANT WILL BE IMMEDIATELY REJECTED FOR EMPLOYMENT OR, IF HIRED, TERMINATED WITHOUT NOTICE FOR GIVING FALSE INFORMATION IN THIS APPLICATION OR FAILING TO ACCURATELY PROVIDE INFORMATION REQUESTED. IF HIRED, EMPLOYMENT IS FOR NO FIXED TERM AND HUMBOLDT GENERAL HOSPITAL OR THE EMPLOYEE CAN TERMINATE EMPLOYMENT AT ANY TIME.

General Information

If yes, please state


High School

Undergraduate College/University


Employment History

Give Last Five Employers in Chronological Order


Give name, address, phone number and years of acquaintance of 3 references who are not related to you and are not previous employers.


To the best of my knowledge, I have truthfully disclosed all information asked for in this application.

I authorize Humboldt General Hospital to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references for the purposes of obtaining information material to my qualifications and suitability for employment. I also hereby release from liability Humboldt General Hospital and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information

I authorize all of those with whom I am acquainted – previous employers, professionals, institutions, neighbors, friends, agencies asked to provide criminal conviction history and others – to furnish any and all information they may have concerning me which may be material to my qualifications and suitability for the job for which I have applied.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or Humboldt General Hospital can terminate this relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.

I understand that if an offer of employment is made, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired.

I understand that if an offer of employment is made, I will be required to undergo a medical examination, drug test, tuberculin skin test, and fingerprint/background check, the results of which may affect my employment.

I represent and acknowledge that I have read and fully understand the foregoing, and that I seek employment under these conditions.

ATTENTION APPLICANT: After you have completed this application, hit the Submit Application button. Please note that your application will be kept under active consideration for no more than 90 days from the date of the application you provide below.

AGREEMENT: I agree that providing my name below is the legally binding equivalent to my handwritten signature.