• 52 Medical Park Drive East Suite 401 Birmingham, Alabama 35235
  • info@osesurg.com
logo
  • Phone
    205.838.3888

Employment Application

  • Home
  •  
  • Employment Application
[]
1 Personal Info
2 Job Details
3 background
4 Employment
5 Military
6 Education
7 SubmitStep 7
OSE EMPLOYMENT APPLICATION
Personal Information
First Name
Last Name
SSN
Address
Address 2
City

 

State
Zip
Phone
In Case of Emergency - Contact Information
Contact Name
Telephone
Address
Job Application Details
Job Applying For
Available Start Date
Desired Shift Hoursbeginning at
ending at
Desired Days
Minimum Salary/Wage
List of Qualifications
0 /
Reasons for Wanting to Work at OSE
0 /
Referred by

I was previously employed by OSE

From
To
Previous OSE Job Title
Criminal History
Nature of Conviction
Location
Conviction Date
Location
Conviction Date
Nature of Conviction
Location
Conviction Date
References

Please list 2 people (other than your relatives) who have direct knowledge of your qualifications and abilities

1.

Name
Address
Phone
Years Known
Occupation

2.

Occupation
Years Known
Address
Phone
Name
Nature of Conviction
Employment History

Please list present and past employers, beginning from the most recent, and so on

1.

Job Title
Company
Address
Supervisor
Phone

Date Range Employed

From
To
Salary/Wage
Reason For Leaving

2.

Job Title
Company
Address
Supervisor
Phone

Date Range Employed

From
To
Salary/Wage
Reason For Leaving

3.

Job Title
Company
Address
Supervisor
Phone

Date Range Employed

From
To
Reason For Leaving
Salary/Wage
Military Service

Are you currently serving in, or have you ever served in, the U.S. military?

If so, which branch were you in, and when did you serve?

Education

High School

Name
Location

Dates Attended

From
To
Major Area of Study
Number of Years Completed
Degree Received

Trade or Tech School

Name
Location

Dates Attended

From
To
Major Area of Study
Number of Years Completed
Degree Received

College

Name
Location

Dates Attended

From
To
Major Area of Study
Number of Years Completed
Degree Received

Other

Name
Location

Dates Attended

From
To
Major Area of Study
Number of Years Completed
Degree Received
Upload Resume
Upload Your Resume
Choose File for Upload
IMPORTANT! Please Read and Sign Below
By filling in the below fields and clicking the Submit button, I understand, represent and voluntarily agree that:
  1. All of the information I have furnished in connection with this application is complete, true and correct.
  2. Any misrepresentation or omission is grounds for dismissal.
  3. OSE may contact my present and former employers, schools, law enforcement authorities and any references to obtain additional job-related information about me. 
  4. I hereby release from liability OSE and its representatives for seeking such information, and all others who furnish such information.
Applicant Nameyour full name
Today's Datedate of submission
Previous
Next
© Copyright - Out Patient Surgery East Surgical Center