Providing excellent, personalized, accessible healthcare services...


FHS Job Application

You will have the option to upload an electronic copy of your resume upon completion of the application...
Position(s) Applied For*
Date of Application:*
How Did You Learn About Us?
If you are under 18 years of age, can you provide required proof of your eligibility to work?
E-mail Address:
Social Security Number (Voluntary)
Best time to contact you:
If YES, give:
Have you ever filed an application with us before?*
If Yes, give date:
Have you ever been employed with us before?*
If Yes, Give date:
Do any of your friends or relatives, other than spouse, work here?*
Are you currently employed?*
May we contact your present employer?*
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status (proof of citizenship or immigration status will be required upon employment)?*
Date you are available for work:*
What is your desired salary range?
Are you available to work:*
For Part-Time employment, please indicate
For Temporary Employment, please tell us dates you are available...
Are you currently on "lay-off" status and subject to recall?
Can you travel if a job requires it?


Elementary School Name:
Elementary School Address:
Elementary Course of Study:
Number of Elementary Years Completed:
Elementary Diploma/Degree:


High School Name:
High School Address:
High School Course of Study:
Number of High School Years Completed:
High School Diploma/Degree:


Undergraduate College Name:
Undergraduate College Address:
Undergraduate College Course of Study:
Number of Undergraduate College Years Completed:
Undergraduate College Diploma/Degree:


Graduate Professional School Name:
Graduate Professional School Address:
Graduate Professional Course of Study:
Number of Graduate Professional School Years Completed:
Graduate Professional Diploma/Degree:

OTHER (Specify)

Other School Name:
Other School Address:
Other School Course of Study:
Number of Other School Years Completed:
Other School Diploma/Degree
Describe any specialized training, apprenticeship, skills, or extra-cirricular activities:
Describe any job-related training received in the United States military:

Employment Experience

1. Employer Name:
Employer 1 Address:
Employer 1 Phone:
Employer 1 Job Title:
Employer 1 Supervisor:
Reason for Leaving Employer 1:
Dates Employed by Employer 1:
Hourly Rate/Salary with Employer 1 Starting:
Hourly Rate/Salary with Employer 1 Final:
Work Performed:
2. Employer Name:
Employer 2 Address:
Employer 2 Phone:
Employer 2 Job Title:
Employer 2 Supervisor:
Reason for Leaving Employer 2:
Dates Employed by Employer 2:
Hourly Rate/Salary with Employer 2 Starting:
Hourly Rate/Salary with Employer 2 Final:
Work Performed at Employer 2:
3. Employer Name:
Employer 3 Address:
Employer 3 Phone:
Employer 3 Job Title:
Employer 3 Supervisor:
Reason for Leaving Employer 3:
Dates Employed by Employer 3:
Hourly Rate/Salary with Employer 3 Starting:
Hourly Rate/Salary with Employer 3 Final:
Work Performed at Employer 3:
4. Employer Name:
Employer 4 Address:
Employer 4 Phone:
Employer 4 Job Title:
Employer 4 Supervisor:
Reason for Leaving Employer 4:
Dates Employed by Employer 4:
Hourly Rate/Salary with Employer 4 Starting:
Hourly Rate/Salary with Employer 4 Final:
Work Performed at Employer 4:
List professional, trade, busines or civic activities and offices held.

Additional Information

Other Qualifications:

Specialized Skills

Check all that apply:
WPM (words per minute):
List Production/Mobile Machinery:
Other Specialized Skills:
State any additional information you feel may be helpful to us in considering your application:
NOTE TO APPLICANTS: Do not answer this question unless you have been informed about the requirements of the job for which you are applying.
Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?
Reference 1 Name:
Reference 1 E-mail:
Reference 1 Phone:
Reference 1 Address:
Reference 2 Name:
Reference 2 E-Mail:
Reference 2 Phone:
Reference 2 Address:
Reference 3 Name:
Reference 3 E-mail:
Reference 3 Phone:
Reference 3 Address:

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whither or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign a any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Electronic Signature:*
Date Signed:*
Upload Your Resume: