Lincoln Medical Education Partnership | EMPLOYMENT APPLICATION

Strengthening Community through Health Education, Research & Patient Care

Applications are only accepted for open positions. We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status. Before being accepted for any position, we will investigate all prior employment, educational records, and criminal history records.

Today's Date
Today's Date
Radio
How did you learn about us?
Name *
Name
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
If "Yes," give date
If "Yes," give date
If "Yes," give date
If "Yes," give date
On what date would you be available to work?
On what date would you be available to work?
High school years completed
Years of undergraduate studies completed.
Years completed of graduate/professional school.
Tell us whether you speak, read and/or write the language, and indicate whether you consider yourself "fluent," "good," or "fair" at the language.
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.
Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status. Do not write ‘see resume.’ Incomplete applications will not be considered.
EMPLOYER ADDRESS *
EMPLOYER ADDRESS
EMPLOYER PHONE NUMBER *
EMPLOYER PHONE NUMBER
DATE YOU STARTED WORK *
DATE YOU STARTED WORK
DATE YOU ENDED EMPLOYMENT *
DATE YOU ENDED EMPLOYMENT
Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status. Do not write ‘see resume.’ Incomplete applications will not be considered.
EMPLOYER ADDRESS *
EMPLOYER ADDRESS
EMPLOYER PHONE NUMBER *
EMPLOYER PHONE NUMBER
DATE YOU STARTED WORK *
DATE YOU STARTED WORK
DATE YOU ENDED EMPLOYMENT *
DATE YOU ENDED EMPLOYMENT
Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status. Do not write ‘see resume.’ Incomplete applications will not be considered.
EMPLOYER ADDRESS *
EMPLOYER ADDRESS
EMPLOYER PHONE NUMBER *
EMPLOYER PHONE NUMBER
DATE YOU STARTED WORK *
DATE YOU STARTED WORK
DATE YOU ENDED EMPLOYMENT *
DATE YOU ENDED EMPLOYMENT
Summarize special job-related skills and qualifications acquired from employment or other experience.
I certify that answers given herein are true and complete to the best of my knowledge. I understand that consideration for employment is conditioned upon the results of reference checks, and that the Lincoln Medical Education Partnership is authorized to investigate all statements I have made in this application, including contacting former employers and references. I understand that a drug test will be required after a conditional offer of employment has been made. I hereby acknowledge that any employment relationship with the Lincoln Medical Education Partnership is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the Lincoln Medical Education Partnership. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Lincoln Medical Education Partnership. NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. The Lincoln Medical Education Partnership participates in E-Verify. We will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. IMPORTANT: If the Government cannot confirm that you are authorized to work, this employer is required to provide you written instructions and an opportunity to contact SSA and/or DHS before taking adverse action against you, including terminating your employment. For more information on E-Verify, please contact DHS at 1-888-464-4218. Employers may not use E-Verify to pre-screen job applicants or to re-verify current employees and may not limit or influence the choice of documents presented for use on the Form I-9. If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 1-800-255-7688 (TDD: 1-800-237-2515).