Auburn Hospital Employment Application

Please select the position you are interested in applying for:

ACH General ApplicationAssistant Director of Environmental Services - Full Time (Evenings)Assistant Director of Nursing - Full Time - Finger Lakes Center for LivingBilling Clerk - Full Time - Auburn Community HospitalCertified Central Sterile TechCertified Nursing Assistants - Finger Lakes Center for LivingClerk Aide - Med/Surg (Full-Time, 7p-7:30a) - Auburn Community HospitalClinical Applications Specialist - Full Time - Auburn Community HospitalClinical Documentation Specialist - Full Time - Auburn Community HospitalClinical Leader - Emergency Care Unit (7p-7a)Clinical Nurse Specialist (CNS)CT Technologist (Full Time) Auburn Community Hospital/$10,000 Sign on BonusDiagnostic Medical Sonographer / Ultrasound TechnologistDietary Services General Kitchen Workers - Part Time - Auburn Community HospitalDietitian - Full TimeDietitian - Part Time - Auburn Community HospitalDietitian - Per Diem - Auburn Community HospitalEmergency Department Nurse Practitioner - Auburn Memorial Medical ServicesEmergency Department Physician - Auburn Memorial Medical ServicesEmergency Department Physician Assistant - Auburn Memorial Medical ServicesEmergency Room Clerk/Tech - Full-Time & Part-TimeEmployee Health Clerk - Per Diem paid InternHelp Desk Technician - Full Time - Auburn Community HospitalHospitalist (NP or PA) Auburn Community HospitalHousekeeping Attendants - Full Time - Auburn Community HospitalHybrid Billing & or Coding Specialist - Full-TimeInfusion/Admitting Clerk Float - Full Time - Auburn Community HospitalInpatient Coder - Part TimeLicensed Nursing Home AdministratorLicensed Practical Nurses (FT and PT) ** NEW RATES!!! ** Generous Sign On Bonus!!LPN - Behavioral Health UnitLPN - CardiologyLPN (Part time and Full time) Finger Lakes Center for LivingLPN/RN Float – (Full Time) – Auburn Memorial Medical ServicesLPN/RN Medical Office – (Full Time) – Auburn Memorial Medical ServicesMaintenance Helper - Full TimeMEDENT Trainer/Billing Specialist - Full-TimeMedical Assistant (Cardiology) - Auburn Community HospitalMedical Director - Auburn Family MedicineMedical Imaging AssistantMedical Records Data Integrity/Deficiency Assistant - Full Time - Auburn Community HospitalMedical Records Operations Manager - Full TimeMedical Staff Services CoordinatorMedical Technologist - Full Time - Auburn Community HospitalMedication Reconciliation TechnicianMRI Technologist - Full TimeNuc Med-PET/CT TechnologistNurse Educator RN - Full time - Finger Lakes Center for LivingNurse Manager - Interventional RadiologyNurse Manager - Medical/Surgical UnitOB TechnicianOncology Authorizations Specialist - Per Diem - Auburn Community HospitalOperating Room Surgical Technician – (FT) Auburn Community Hospital - $5,000 Sign On BonusPatient / Material Transport AidePatient Care Assistant - Medical/SurgicalPatient Care Assistant (PCA) - Critical Care UnitPatient Care Representative - Part time 2p-7p and 3p-7p M-F - RadiologyPharmacy Technician & Medication Reconciliation TechniciansPhysical Therapist - Full TimeQuality Management/Emergency Preparedness Registered NurseRadiation TherapistRadiologic Technologist - Cardiac Cath LabRadiologic Technologist (Full time) - Auburn Community Hospital/$10,000 Sign on BonusRadiology Patient Care Representative - Part TimeRegistered Dietitian - Full Time (Temporary) - Finger Lakes Center for LivingRegistered Nurse - Behavioral Health UnitRegistered Nurse - Cardiac Cath LabRegistered Nurse - Dialysis/Med Surg FloatRegistered Nurse - Emergency Room ($15,000 Sign-On Bonus)Registered Nurse - Med/Surg ($10,000 Sign On Bonus)Registered Nurse - Operating Room (Sign On Bonus)Registered Nurse (RN) - OB/L&D - Auburn Community HospitalRegistration Clerks - Full Time & Part-TimeRespiratory Care Therapist - $10,000 Sign-On BonusSecurity Guard - Full Time & Part TimeSocial Worker, Emergency Department - Per DiemSpeech Language Pathologist (SLP)Surgery Scheduler - CardiologyUltrasound Technologist - Full TimeUnit Secretary - Critical Care Unit (Part-Time)Urgent Care - Physician Assistant / Family Nurse Practitioner (Full Time) - Auburn Community Hospital

Applicant Personal Information

Disclaimer: Positions listed below may not be available at the time of application, however, all applicants will be placed into a pool and considered when job availability opens up.

Which area of the hospital are you interested in working (required)?
—Please choose an option—Auburn Memorial Medical ServicesBariatricsBehavioral HealthCardiologyCare TransitionsCentral SterileCodingCritical CareDietaryEmergency RoomFinger Lakes Center for LivingHIMHousekeepingHuman ResourcesInformation TechnologyLabsMaintenanceMaterials ManagementNursingOB/GYNOncologyOperating RoomOrthopedicsPatient AccessPharmacyPhlebotomyPhysical TherapyPodiatryRadiologyRespiratory TherapySecurityUrgent Care

First Name (required)

Middle Name

Last Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Home Phone (required)

Cell Phone

Work Phone

E-Mail Address (required)

Have you ever been employed at Auburn Community Hospital, Auburn Memorial Medical Services (AMMS, PC) or the Finger Lakes Center For Living? (required)
YesNo

If so, when?

How did you learn of this position?
—Please choose an option—Employee ReferralWalk InMonster.comCareer BuilderJob FairTemp AgencyCollege RelationsOpen HouseExternshipAdCommunity or Other AgencyOther

Additional Information

If ad, friend, relative, job fair or other, specify

Employment History

Date Available for Work (required)

Type of Employment Desired
No preferenceFull-timePart-timePRNWeekendOvernightTemporarySummerPer Diem

Are you willing to work weekends? (required)
YesNo

Are you willing to work holidays? (required)
YesNo

Are you legally authorized to work in the US? (required)
YesNo

Are you 18 years of age or older? (required)
YesNo

Have you applied for employment with our organization within the past two years? (required)
YesNo

Do you have any employment commitments with any other employer, including any form of self-employment or contract work, which you expect to keep even if you are hired by our company? (required)
YesNo

Have you ever been known by a different name? (required)
YesNo

Can you perform the essential functions of the job for which you are applying with or without reasonable accommodations? (required)
YesNo

Enter Name & Location of all High Schools, Vocational Schools, Business Schools, Colleges, and Related Military Courses attended.

High School

Name

City

State

Zip

Course/Study

# of Years of High School Completed

Graduate?
—Please choose an option—YesNo

College

Name

City

State

Zip

Course/Study

# of Years of College Completed

Graduate?
—Please choose an option—YesNo

Degree

Other Trade, Business, Night or Correspondence School

Name

City

State

Zip

Course/Study

Zip

Graduate?
—Please choose an option—YesNo

Degree

Typing
YesNo

Typing Words Per Minute

Medical Terminology Knowledge
YesNo

Medical Coding
YesNo

List Computer Program Knowledge

Are there any other special experiences or skills you feel would especially qualify you for the position?

Branch of Service

From

To

Rank at Discharge

Date of Final Discharge

Describe your duties & any special training which may be related to the position(s) for which you are applying

Type

Organization

State Issued

Number

Expiration

Job Opportunity

Reference 1

Name

Relationship

Telephone

E-Mail Address

Reference 2

Name

Relationship

Telephone

E-Mail Address

Reference 3

Name

Relationship

Telephone

E-Mail Address

Employer 1

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

Employer 2

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

Employer 3

Company Name

Phone

Address

City

State

Zip

Employed

From

To

Name/Title of Immediate Supervisor

Job Title

Describe your work/responsibilities

Reason for Leaving

May we contact the employer?
—Please choose an option—YesNo

If you wish, you can upload a resume/cover letter below.

Gender
MaleFemaleOtherPrefer Not to Say

Veteran Status
YesNoPrefer Not to Say

Have you been a resident of New York for the past two consecutive years? (required)
YesNo

Have you ever been convicted in any state of the United States of a felony or misdemeanor? (required)
YesNo

Are there any criminal charges pending against you anywhere? (required)
YesNo

Have you ever been convicted of an offense (misdemeanor or felony) other than a minor traffic violation? (Driving under the influence [DUI] and Driving while intoxicated [DWI] convictions are not minor and must be reported.)
YesNo

Have you ever been found guilty of a criminal offense?
YesNo

Have you ever been imprisoned or jailed in a criminal proceeding?
YesNo

A "yes" to any questions above does not automatically keep you from being hired. If you answered "yes" to any questions you must fully explain.

Your omission or falsification of any criminal history, or any disclosure required by this form, is a cause for dismissal from employment or consideration for employment.

Examples of a criminal offense: Assault/battery, auto theft, disorderly conduct, domestic violence, DUI/DWI, fraud ( welfare/food stamps) loitering, prostitution/solicitation, robbery, shoplifting, theft (grand/petty), trespassing, worthless checks. Note: This is not a complete list and is intended to provide examples only. You must list all convictions including juvenile incidents and those in which adjudication was withheld and/or records were sealed/expunged.

I verify that this information is true, and that I have not been convicted of any crime that would disqualify me from the position(s) for which I am applying. I hereby authorize company to request, obtain and examine any and all records that may relate to my arrest, conviction and/or imprisonment at any time for any felony or misdemeanor and I expressly release and hold harmless any party providing the aforementioned criminal information requested by company. (required)

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