Glacial Ridge Health System
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10 Fourth Avenue SE
Glenwood, MN 56334
866.667.4747


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"I wanted to work for GRHS because it was a nice, progressive hospital and I knew I would get to care for patients requiring different types of care. I continue to work here because I enjoy working with my co-workers. We work well together for the good of the patients."

- Nikki, (LPN)

"After working in the lab for 24 years, I've gotten to know the patients - my friends and neighbors - and they have become my second family. I am also proud to care for the community in which I live."

- Peggy, (Laboratory Manager)

Tell us your story.
We'd love to hear it!
Click here.

AN EQUAL OPPORTUNITY EMPLOYER
Glacial Ridge Health System is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.

Please fill out all sections.

APPLICATION INFORMATION

Name (First, Middle, Last):

Current Address

City

State

Zip

E-mail Address:

Home Phone:


Cell Phone:
How were you referred to our company?

EMPLOYMENT POSITIONS

Position(s) Requested:
1)
2)
Please select the type of work you are applying for.
Part-time     Full-time     Temporary (summer/holiday)
Are you able to meet the attendance requirements of this position?
Yes     No   
Driver's License Number (if job related)

Which days/hours are you available. Please list all that apply.

Can you work weekends?
Yes     No   
Can you work holidays?
Yes     No  
Are you available to work overtimes?
Yes     No  
Salary Desired $

PERSONAL INFORMATION

Have you ever applied to/worked for Glacial Ridge Health System before?
Yes     No   

Do you have any friends, relatives, or acquaintances working for this company?
Yes     No 
State name/relationship, acquaintance(s):

If hired, would you have transportation to/from work?
Yes     No 

Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.)
Yes     No   

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
Yes     No   

Are you able to perform the essential functions of the job for which you are applying, either with/without reasonable accommodation?
Yes     No   
If No, describe the functions that cannot be performed:
NOTE: Company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes     No   
If Yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case:

NOTE: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that
affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

EDUCATION, TRAINING AND EXPERIENCE

High School
Name of School:
Did You Graduate?:
Address:
Type of Degree:
Field of Study:
Business School, Vocational, or Correspondence School
Name of School:
Did You Graduate?:
Address:
Type of Degree:
Field of Study:
College or University
Name of School:
Did You Graduate?:
Address:
Type of Degree:
Field of Study:

EMPLOYMENT HISTORY

Present or Last Employer
Name:
Address:
Phone:
Supervisor:
Your Title:
Duties:
Last Salary:
Reason for Leaving:
Date Left (Month / Year)
Date Began (Month / Year)
May We Contact?:
Previous Employer 1
Name:
Address:
Phone:
Supervisor:
Your Title:
Duties:
Last Salary:
Reason for Leaving:
Date Left (Month / Year)
Date Began (Month / Year)
May We Contact?:
Previous Employer 2
Name:
Address:
Phone:
Supervisor:
Your Title:
Duties:
Last Salary:
Reason for Leaving:
Date Left (Month / Year)
Date Began (Month / Year)
May We Contact?:

 

 

 

REFERENCES
Please list below three persons who have knowledge of your work performance within the last four years. Please include professional references only, not personal references.

Name:
Occupation:
Address:
Telephone:

Name:
Occupation:
Address:
Telephone:

Name:
Occupation:

Address:

Telephone:

Resume (Word or PDF files only!):


Please read the following, before submitting your application.

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true &
correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.

I permit the company to examine my references, record of employment, education record, and any other information I have provided.

I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of
such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or
liabilities arising out of or in any way related to such examination or revelation.

This application is current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be
necessary to fill out a new application.

 
 
 
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Glacial Ridge Health System • 10 Fourth Avenue SE • Glenwood, MN 56334 • 866.667.4747          

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