Employment Application

Complete even if including resume

Please provide 3 references

Some people gain job-related experience in positions other than as an employee. (Please omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose.)

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment.

Applicants and employees during their employment are treated without regard to their race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, familial status, disability, sexual orientation, age, or any other legally protected status. Johnson Memorial Health Services is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites applicants and employees to voluntarily self-identify their race or ethnicity. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Please read carefully and check each paragraph before submitting.