RGH Employment Application

Please complete the informtion requested on the form below and submit electronically, or down load the form and mail or drop of at the hospital.

Personal Information: (* required fields)
* First Name:	Middle:
* Last Name:
* Permanent Street Address:
* City, State, Zip Code:	,
* Daytime Phone:	* Evening Phone:
Social Security #:	Email Address:
Position:
* Position Applied For:	Available Start Date:
If hired could you give written proof of right to work in the US? Yes: No:
	Full Time: Part-Time: Temporary:
Education, Licenses/Certifications:
High School:	College: Technical School:
License(s):
Previous Employment:
Company Name:
Address:
City, State, Zip Code:	,
Phone:
Job Title:
Start Date:	End Date:

Company Name:
Address:
City, State, Zip Code:	,
Phone:
Job Title:
Start Date:	End Date:

We again thank you for your interest in employment with Rappahannock General Hospital. To further describe the employment process: Application includes but is not limited to the following: Completion of an application (in full) at the time of interview Verification of current education, license, registration, and other credentials Background investigation including criminal record Completion of a physical and pre-employment drug test Our mission statement is to provide quality, compassionate care to all patients. We have successfully achieved our mission by building a staff of qualified, skilled professionals that are focused on patient care, and service to our community and our customers. We ask all employees to be similarly dedicated to compassionate care and service to others. Rappahannock General Hospital : Appreciating diversity and respecting the individual (EOE) Drug Free Workplace (DFW) -------------------------------------------------------------------------------- If mailing this application instead of submitting it electronically, please send it to the following address: Human Resources Department Rappahannock General Hospital P.O. Box 1449 Kilmarnock, VA 22482 Rappahannock General Hospital is an Equal Opportunity/Affirmative Action employer.