Application for Employment


It is the policy of Ellenville Regional Hospital to provide for and promote the equal opportunity of employment, compensation and other terms and conditions of employment without discrimination because of age, race, creed, color, national origin, gender, disability, or marital status. No question on this application is intended to secure information to be used for such discrimination.

Please have all your information ready (employment history, references, certifications, etc.) before you begin. You will not be able to save and return later.

1 Personal Data
2 Education & Training
3 Employment History
4 Professional License
5 References
6 Agreement
7 Mission, Vision and Values
  • Personal Data

  • Enter only the last 4 numbers
    Check all that apply.
    If YES, verification will be required upon employment.
    If NO, hire is subject to verification that you are of minimum legal age.
    Check all that apply.
  • If you answer YES to any of the questions A-E below, you must give specifics. If such explanation is insufficient, a confidential investigation supplement will be sent to you. None of the circumstances below represents an automatic bar to employment. Each case is considered and evaluated on individual merits in relation to the duties and responsibilities of the position(s) for which you are applying.