Join Our Team

Personal Information

First Name *

M.I.

Last Name *

Home Address *

APT.#

City *

State *

Zip Code *

Phone *

Email Address *

IF HIRED YOU WILL BE REQUIRED TO SUBMIT PROOF OF AGE IF UNDER 18 AND YOU WILL BE REQUIRED TO HAVE A VALID WORK PERMIT. *

I am under 18

I am 18 or older

Position Applying For *

Date Available * +

Are you legally authorized to work in the United States? *

Yes

Have you ever been convicted of a felony? *

Yes

If yes, please explain.

0/250 characters

Hours and Shift Availability

Previous Applications

How were you referred to us? *

Current employee

Online job search

BRMC website

Other

Are you related to any present of BRMC? *

Yes

If yes, who?

Are you able to perform the essential functions of the positions for which you are applying, either with or without reasonable accommodations(s)? (Job description available for your review in Human Resources) *

Yes

In necessary, please describe what type(s) of reasonable accommodation(s) is/are needed:

0/250 characters

If offered employment, can you submit verification of your legal right to work in the United States? *

Yes

Military Information

Have you served in the military? *

Yes

Special Skills and Training

Shorthand *

Yes

Speed

Typing *

Yes

Speed

Word Processing *

Yes

Speed

Spreadsheet *

Yes

Software used

Medical Terminology *

Yes

Experienced using hospital computer system? *

Yes

Education

School name

City & State

Employment History

Employer 1

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

Employer 2

Company Name

Address

Phone

Start Date +

End Date +

Position

Salary

Supervisor/Manager

Reason for Leaving

May we contact? *

Yes

Phone Number

References

Reference 1

Name

Title

Email Address

Phone

Reference 2

Name

Title

Email Address

Phone

Reference 3

Name

Title

Email Address

Phone

Job Related Experience:

List any additional skills that you would like to mention.

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