We are an Equal Opportunity Employer

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* 1. Personal Information

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* 2. Position applied for:

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* 3. Are you age 18 or older?

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* 4. Date you can start:

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* 5. Desired Salary

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* 6. Have you applied to PC&HC before?

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* 7. Can you perform the essential functions of the job you are applying for with or without a reasonable accomodation?

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* 8. Availability

Employment History (Start with most recent employer)

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* 10. Previous Employer

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* 11. Describe the work performed: 

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* 12. Previous Employer

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* 13. Describe the work performed: 

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* 14. Previous Employer

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* 15. Describe the work performed: 

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* 16. Personal Reference

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* 17. Professional Reference

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* 18. Professional Reference

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* 19. Are you legally eligible to work in the US?

I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment regardless of when or how discovered.

It is the policy of Primary Care & Hope Clinic to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, sexual orientation, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, or any other characteristic protected by Federal, State or Local Law.

If hired, I understand that my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or me.

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* 20. I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

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* 21. Sign Electronically

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* 22. Please send your resume to jobs@hopeclnc.org

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