Employment Application

2024 Online Employment Application

Salem Township Hospital is an equal opportunity provider and employer. Applicants for employment are recruited and hired on the basis of merit, qualifications, previous experience, and ability to perform the available work. The Hospital does not discriminate against any qualified applicant on the basis of race, color, religion, spiritual beliefs, sexual orientation, national origin, age, gender, disability, or other characteristics protected by federal, state or local law unrelated to job requirements. In considering your application for employment, the facility may conduct a detailed and thorough investigation which may include but is not limited to a criminal record check, interviews or inquiries of prior employers, coworkers, acquaintances, relatives or friends.

Please complete all sections of the application. *Indicates Required Fields.

Personal Information

Address *
Include maiden name

Position & Availability

Name, Dept, Relationship
Referred by an employee? *


Include Special Military Training, Post Graduate and Nursing
Include Word Processing, approximate WPM

Licensing & Certification

List Type, State, No., and Date

Professional Experience

Employer Name & Address *
Employer Name & Address


Professional/Work/School references (Not relatives or personal acquaintances)

Additional Background Information

You are not required to disclose any sealed or expunged criminal records

Acknowledgement & E-Signature

Carefully read this section prior to providing signature. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that employment may be conditioned upon successfully passing a medical examination and that I may be required to satisfactorily complete a drug screening as a condition of employment. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information. I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for written agreement signed by an administrative representative of this facility and notarized.




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