Dove Healthcare

Employment Application

 

Thank you for your interest in working for Dove Healthcare. We look forward to receiving your application.

Which position are you interested in?

If the position for which you are applying is not available, are you willing to be considered for a similar position at another Dove Healthcare facility?         

First Name: *

Middle Inital: *

Last Name: *

Primary Phone: *

Secondary Phone:

Address: *

City: *

State: *

Zip: *

Email: *

Where did you hear about this position? *

Have you ever worked at any Dove Healthcare location?         

Have you ever applied at any Dove Healthcare location?         

Conviction of a crime is not an automatic bar to consideration for employment.

Have you ever pleaded guilty to or been convicted of any criminal offense, excluding minor traffic citations? *        

Are you currently serving probation or any deferred adjudication for a criminal offense? *         

Our facilities are drug, alcohol, and smoke free workplaces. Could you comply with this regulation? *        

Are you a veteran? *        

Please list, in order of preference, the position(s), for which you wish to be considered:

List any additional trades or qualifications you may have for the position you have applied for:

If the position you are applying for requires certification or licensing, do you have or are you seeking a current Wisconsin certification/license?
    

How experienced are you in the position you have requested? Experience in years/months:  

Date Available for Employment:
         

Salary/Wage Desired:

Number of desired hours per week: 

Shift Preference (Indicate 1 for 1st choice and 2 for 2nd choice.):

First Shift     Second Shift     Third Shift     Weekends     Other:

Uploading a resume is optional.
If you choose to upload a resume, you can skip the "Work History" sections below and proceed to the next section.

Cover Letter:

Resume:

Past Education

Do you have a high school diploma or GED?         

GED or High School City:

In the spaces below, please list any additional schools beyond High School/GED that you have attended, number of years completed, degrees received, and your primary area of study.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Add more education.

School/City/State:

Years Completed:

Estimated Completion:
 

Degree:

Major/Minor:

Work History

Please provide your employment data for the last seven years. List your current or most recent position first. Explain all periods of unemployment. References will be required before employment.

May we contact your present employer at this time?         

Have you ever been discharged or requested to resign?         

Present or Last Employer #1:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:   to       

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #2:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #3:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #4:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #5:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #6:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #7:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #8:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #9:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

Add another employer.

Present or Last Employer #10:

Supervisor Name:

Phone:

Address, City, State, Zip:

Starting Hourly Rate:

Ending Hourly Rate:

Dates Employed:     

Position(s) Held and Major Job Duties:

Reason for Leaving:

References

Please list two work and/or education related references. Do not list friends or relatives.

Name:

Relationship:

Phone:

Agreement

I verify that all the information which I have provided on this application and in resumes/exhibits is true, correct and complete. I understand that false, misleading, incomplete or omitted information will result in rejection of my application or dismissal from employment, whenever discovered. If my application is considered for employment, I authorize an investigation and verification of all information and statements provided on this application and in resumes and exhibits. I release any and all persons or companies from any liability for releasing information or verifying statements on this application and in resumes/exhibits.

I understand that this application is not a job offer or a contract of employment for any specific time period. If hired, my employment will be for an indefinite time period and I may resign or be terminated by the facility at any time without notice or requirement of cause.

Employment is subject to completion of pre-employment procedure, including but not limited to verifying employment personal references, criminal record and driving record (where appropriate), and confirmation of professional licensure or registration. Applicants hired must complete a federal I-9 form and provide verifying documentation of their legal right to reside and work in the United States.

Applicants extended a conditional job offer may be asked to submit to a medical exam by a medical practitioner selected by the facility. The exam results will be communicated to the facility and used to determine suitability for employment. In conducting the medical exam, the facility will reasonably accommodate the disabilities and handicaps of qualified applicants in compliance with applicable law. Applicants who refuse to submit to a medical examination will not be further considered for employment.

I further agree that if employed, I will comply with all policies, rules and procedures of the facility. I further give consent for the facility for which I am applying to contact former employers to obtain references and verify information as needed.

By signing and dating this form, I hereby swear all the above information is correct.

My typed first and last names below shall have the same force and effect as my written signature.

First Name:

Last Name:

Date: