The Health and Wellness Center - FQHC
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Employment Application

EMPLOYMENT APPLICATION

SHWC, Inc. is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. You must specify the position in which you are applying. Any application found to be incomplete will be discarded. This application will be considered active for the position applied for 90 days following receipt. Consideration for employment after 90 days requires a new application.

Personal Data

Have you used other names?
Please let us know which listed position you are applying for.
Available to work?
Please select at least one.
Can you travel if required?
Are you 18 years of age or older?
If under 18, can you, upon employment, submit a work permit?
Have you previously applied for a position with our company?
Have you been previously employed with our company?
Do you have any relatives working within our company?
Are you legally authorized to work in the U.S.?
(If offered employment, you will be required to provide documentation to verify eligibility.)
Have you ever been convicted of a felony?
Are you currently employed?
May we contact your present employer?
Select One

Education

Please list all, beginning with the most recent.
Did you graduate?
Did you graduate?
Did you graduate?

Employment History

Include your last 7 years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.
May we contact this employer?
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May we contact this employer?
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Are you currently serving or have you served in a branch of the U.S. Military?

Military Service

Personal References

Give names of at least three persons who have experience in observing and working with you and who can provide adequate references pertaining to your professional competence, moral integrity, character, and ethics.
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Disclaimer and Signature

I certify that the above answers are all accurate and complete to the best of my knowledge. If this application leads to employment, I understand that any significant misstatements in or omissions from this application or in my interview may result in my dismissal from Stigler Health & Wellness Center, Inc.

Authorization for Background Investigation

I understand that I may be employed by Stigler Health & Wellness Center, Inc. subject to a thorough background investigation and a report from the Oklahoma State Bureau of Investigation stating that I have no felony or misdemeanor charges against me except for misdemeanor traffic violations. I understand that the purpose of the investigation is to reduce the potential for abuse, neglect or explanation of service recipients. I understand I may not be employed if the investigations do not meet SHWC’s contract guidelines. I also authorize Stigler Health & Wellness Center, Inc. to contact any of my previous employers and I will hold harmless of any statement made against me concerning my previous work history.

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