Employment Application
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Kern Valley Healthcare District is an equal opportunity employer and as such considers individuals for employment according to their abilities and performance without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, or sexual orientation.
Please Read Carefully ~ Answer All Questions
Today's Date Date Available
If offered employment by Kern Valley Healthcare District you will be required to successfully pass a urine drug screen and a physical examination.
Personal Data
Last Name
First Name Initial
Email Address
Address
City
State Zip Code
Phone # Cell #
Position Desired
Employed Previously at KVHD? Select One Yes No
Type of employment desired (check all that apply)
Full Time Part Time Per Diem Will work overtime
Are you legally able to work in the United States? Select One Yes No
Are you over the age of 18? Select One Yes No
Other than traffic violations, have you even been convicted of a crime? Convictions may not be a reason for disqualification. Select One Yes No
If yes, describe in detail:
Education and Training
High School/Trade School
Name of School
Location
Diploma? Select One Yes No
Business/Technical School
Dates Attended
Degree(s) Earned
Major/Minor fields of Study
Colleges
Other Training
Professional Licensure
Type
State Issued
Number
Date Received
Expiration Date
Work Experience
Present/Last Employer
Name
Type of Business
Phone
Start Date
Leave Date
Salary
Reason for Leaving
Job Title
Supervisor & Title
Description of Job Duties
May we contact? Select One Yes No
Past Employer #1
Past Employer #2
Careers at KVHD. Check out current opportunities in nursing, laboratory, and more at KVHD.
