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LVMC Job Application

Job Information

*Represents a mandatory field.


 *Job Recruitment Number:        *Job Title:   

Job Recruitment Numbers can be found HERE.

Please fill out the application completely (if not applicable, write N/A).  Once completed on page 4, click the review button at the bottom of the application to review your application before final processing.  

If you would like to add your resumé to this application, you will be prompted for your file on the review screen before submitting your application. Please Note:  A resumé will not substitute for a complete application form.

General Information

*Name 

 Date  05/16/2008

First

Middle

Last

*Current Address 

Street Address

City

State

Zip Code

*Home Phone 

Other Phone 

E-Mail Address 

*Are you younger than 18 years of age?
Yes No

If yes, age

*Other names under which you were employed?
  1. *Are you or have you ever been employed by the Lompoc Valley Medical Center?
    YesNo

    If yes, under what name(s)?
    Dates?
    Position(s)?
  1. *Do you have any relatives employed by the Lompoc Valley Medical Center?
    Yes No

    If yes, who?
    Relationship?
  1. *Have you ever been convicted by any court of a crime, other than a minor traffic violation; or been disbarred or excluded in participating in any federal or state health care program?
    Yes No

    If yes, please explain.

    (Note:  Unless stated on job announcement, a conviction is not an automatic bar to employment.)
  1. *Are you able to perform the duties of the position for which you are applying, either with or without reasonable accommodations?
    Yes No
  1. *Are you legally authorized to work for the Lompoc Valley Medical Center in the job for which you are applying, in the United States, now and in the future without requiring the Lompoc Valley Medical Center to sponsor you for employment visa status?
    Yes No
  1. *Have you ever been discharged, forced to resign, or rejected during a probationary period from any employment within the last ten years?
    Yes No
    If yes, name of employer(s)?
    Reason(s)?
    Dates?

    (Note:  Answering yes is not necessarily a bar to employment. Each case is given individual consideration.)

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*Please Note: for your convenience, information entered on this form will be stored until the application is completed or until your browser window is closed. If you choose not to finish and submit this application, please close your browser window for the safety of your personal information.