You are applying for:
Title: General Application at Chambersburg Hospital

To make data entry quicker:

  1. Collect all the information necessary before beginning the application process.
  2. Complete the employment history for up to 4 previous employers.
  3. Complete the education history.
  4. Do not copy and paste into the application fields.

Upon submission of your completed application, you will receive a confirmation number. Please record this number for your records. If you do not receive a confirmation number after submitting your application, please contact the Help Desk at the following:

  • (717)262-4488
Optional Resume Attachments:

File Upload Notes:

  • The file can be no larger than 2MB.
  • The following are the only file types accepted:
    • .PDF
    • .RTF
    • .DOC
    • .TXT
    • .DOCX


 
 
Key Information:
Days Nights Evenings
Weekends Overtime On-Call Holidays
Full-Time Part-Time Temporary Relief
Personal Information:
Note: Proof of citizenship or immigration status will be required upon employment.

Note: A conviction record will not necessarily be a bar to employment. This information will be used only for job-related purposes and only to the extent premitted by applicable law.

Limit of 4,000 characters.
Education:
Limit of 300 characters.
Limit of 300 characters.



Limit of 300 characters.
Limit of 300 characters.



Limit of 300 characters.
Limit of 300 characters.



Limit of 300 characters.
Limit of 300 characters.
Adult Pediatric Infant 2 Person

Skills:
Typing     WPM:
Transcription Equipment Medical Terminology Data Entry
Other

Limit of 4,000 characters.

Indicate your specific skills related to possible employment (including PC, software, operation of equipment, etc.).

Limit of 4,000 characters.



Speak: Read: Write:


Speak: Read: Write:

Summarize special job-related skills and qualifications acquired from employment or other experience.

Limit of 4,000 characters.
Employment and Military:
  • Employer 1 is required.
  • If you do not have an employer please fill in the fields with NA.
  • DO NOT enter "please see resume."






If still employed enter 'Present'.
Limit of 1000 characters.
Limit of 200 characters.
  Yes.
 








Limit of 1000 characters.
Limit of 200 characters.
 








Limit of 1000 characters.
Limit of 200 characters.
 








Limit of 1000 characters.
Limit of 200 characters.
 


Limit of 4000 characters.
Professional References:

Three School or Work References Required. No Relatives.







DISCLAIMER

Chambersburg Hospital is an equal opportunity employer and, in conformity with applicable laws, does not discriminate with regard to race, color, creed, religion, sex, national origin, age, disability or veteran status.

By submitting this information, I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by the Chambersburg Hospital unless I have indicated to the contrary. I hereby authorize the Chambersburg Hospital to contact any and all corportations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts, and military services to release information about my background including, but not limited to, information about employment, education, consumer credit history, driving record, criminal record and general public records to the Chambersburg Hospital. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the Chambersburg Hospital, as well as, from any use or disclosure of such information by the Chambersburg Hospital or any of its agents, employees, or representatives.

I understand that misrepresentation, falsification, or material omission of information on this application may result in failure to receive any offer or, if I am hired, in my immediate dismissal from employment.

In consideration of my employment, I agree to conform to the rules and standards of the Chambersburg Hospital, as amended from time to time at the Chambersburg Hospital's sole discretion. I understand that this application or an offer of employment does not create a contract of employment express or implied, nor does it guarantee employment for any definite period of time. I know that this application or the offer of employment does not change the "at-will" relationship between the Chambersburg Hospital and any of its prospective employees. I further agree that my employment and compensation can be terminated at-will, with or without cause, and with or without notice, at any time, either at my option or the option of the Chambersburg Hospital. I understand that no employee, or representative of the Chambersburg Hospital, other than the President of the Chambersburg Hospital, has the authority to enter into any agreement for employment for any specified period of time, or make any express or implied agreement contrary to the foregoing. Further, the President of the Chambersburg Hospital may not alter the at-will nature of the employment relationship or enter into any employment agreement for a specified time unless the President and I both sign a written agreement that clearly and expressly specifies the intent to do so. I agree that this shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or collateral agreements regarding this issue.

I also understand that all offers of employment are conditioned on the receipt of satisfactory responses to references, criminal history, FBI fingerprint and child abuse clearance background checks, etc. I understand that a physical examination, including drug testing and analysis, is part of the employment process and that failure to submit to such examination and testing without prior arrangements with the Chambersburg Hospital and the physician performing the examination will result in denial of employment.

I certify that I completed this application without assistance from another person.

NOTE: If you do not understand or need clarification of any of the above statements, please speak to a member of the Human Resources Department staff BEFORE submitting the application.