Employment Application

Thank you for considering The LSU Healthcare Network for potential employment.

This application will only be considered with the submission of a resume; declaration of position preferred; and location of desired open position.  



POSITION DETAILS

Positions Preferred
Preferred Location
APPLICANT INFORMATION

Last Name, First Name
Middle Name
Primary Phone Number
Secondary Phone Number
Email Address
Address
City, State
Zip Code
Are You Over 18?    Yes
   No
Can you upon hire, provide proof of your legal right to work in the US?    Yes
   No

EMPLOYMENT INFORMATION

Expected Salary
Type of Employment Desired
Have you ever been previously employed by LSU Healthcare Network?    Yes
   No
If yes, Please provide your dates of employment
Other Names Used

Date Available for Work
Have you ever been convicted of a criminal offense? (Omit traffic violations or convictions for which the record has been sealed or expunged by court order)    Yes
   No
How were you referred to LSU Healthcare Network?
Referring Employee(s) Name
Do you have any relatives who work for LSU Healthcare Network?    Yes
   No
If yes, Please indicate the names:

EDUCATION BACKGROUND


High School or GED. Please provide name and location of school
Date Granted
Did you graduate?    Yes
   No
College/Technical/Professional. Please provide name and location of school
Did you Graduate?    Yes
   No
Degree Earned
Date Granted
Course of Study/Major

Additional Education
Did you graduate?    Yes
   No
Degree Earned
Date Granted
Course of Study/Major?
Additional Training, Certificates, Activities, Skills or Accomplishments

REFERENCES


Please give the Names and Business Telephone Numbers of people who are familiar with your work experience and technical competence in the job for which you are applying, preferably technical associates with whom you have worked with and give LSU Healthcare Network permission to contact (Do not list personal references)


1. Reference Name
Professional Relationship
Business Telephone

2. Reference Name
Professional Relationship
Business Telephone

3. Reference Name
Professional Relationship
Business Telephone
EMPLOYMENT HISTORY

1. Name of Most Recent Employer
Address/City, State/Zip Code/Phone Number
Job Title
Date Employed (From-To)
Beginning Salary-Ending Salary
Describe Major Duties
Supervisor`s Name
May We Contact    Yes
   No
Reason for Leaving

2. Name of Employer
Address/City, State/Zip Code/Phone Number
Job Title
Date Employed (From-To)
Beginning Salary-Ending Salary
Describe Major Work Duties
Supervisor`s Name
May we contact?    Yes
   No
Reason for Leaving

3. Name of Employer
Address/City, State/Zip Code/Phone Number
Job Title
Date Employed (From-To)
Beginning Salary-Ending Salary
Describe Major Duties
Supervisor`s Name
May We Contact    Yes
   No
Reason for Leaving
I certify that all the information provided on this form is true and complete to he best of my knowledge, and I understand that any misinterpretation, falsification or omission may be considered justification for refusal of employment or subsequent termination. I understand that employment by LSU Healthcare Network is conditional upon completion of an Employment Agreement. I further understand that my employment is at the discretion of LSU Healthcare Network and it has no specified term. It can be terminated at will, with or without notice, at any time, for any or no reason, at the option of either LSU Healthcare network or myself

ANY APPLICATIONS SUBMITTED WITHOUT A RESUME WILL NOT BE CONSIDERED
Ceritfication
Upload Resume     Upload
To help prevent automated submissions, please enter the letters in the image below.  
     Reload Image
   

Items in RED are required.
 Submit     Reset

 

© Copyright 2017, LSU Healthcare Network. All rights reserved.