Ortho Four States – Orthopaedic Specialist of the Four States

(417)206-7846

Employment Application

Personal Information

First Name *

Last Name *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Email Address *

Phone *

Alternative Phone

Attach Resume
Please attach a doc, docx, or pdf only.


Position

Which position are you applying for? *

How did you hear about this position?

When can you start?*

What would be your desired hours?

Salary Requirements *


School Information #1

Name of School

City

State

Date of Graduation

Degree/Diploma


School Information #2

Name of School

City

State

Date of Graduation

Degree/Diploma


School Information #3

Name of School

City

State

Date of Graduation

Degree/Diploma


Employment History #1

Name of Employer

Start Date

End Date

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Starting Pay

Ending Pay

Job Position and Title

Essential Job Functions

Reason for Leaving

Is this your current employment?

May we contact?


Employment History #2

Name of Employer

Start Date

End Date

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Starting Pay

Ending Pay

Job Position and Title

Essential Job Functions

Reason for Leaving

Is this your current employment?

May we contact?


Employment History #3

Name of Employer

Start Date

End Date

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Starting Pay

Ending Pay

Job Position and Title

Essential Job Functions

Reason for Leaving

Is this your current employment?

May we contact?


Military History

Proceed past the military section if not applicable.

Branch

Start

End

Rank at Discharge

Type of Discharge

If other than honorable, please explain.


Have you ever been employed with this company before?

Do you have any friends or relatives employed by this company?

If yes, please list.

Are you on "layoff" and subject to recall?

If you are under 18 years of age, can you provide proof of your eligibility to work? *

If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.? *

If hired, do you have a reliable means of transportation to and from work?

If hired, would you be able to travel or work overtime or weekends as needed?

Have you ever been convicted of a felony? *

Personal Reference

Professional Reference

Additional Comments (Expand on any points or questions asked previously in this application).

I certify that my answers are true and complete to the best of my knowledge. *


PreEmployment drug testing is required of all applicants. All employment offers are conditional upon a negative drug screening test.

*Application must be thoroughly completed. Incomplete applications will not be considered. Employment with Orthopaedic Specialists of the Four States is a voluntary one and is subject to termination by you or Orthopaedic Specialists of the Four States at will, with or without cause, and with or without notice, at any time. Nothing in these policies shall be interpreted to be in conflict with or to eliminate or modify in any way the employment at will status of Orthopaedic Specialists of the Four States employees. This policy of employment at will may not be modified by any officer or employee and shall not be modified in any publication or document. The only exception to this policy is a written employment agreement approved at the discretion of the President or the Board of Directors, whichever is applicable.

Orthopaedic Specialists of the Four States (Ortho Four States)
444 Four States Dr Suite 1, Galena, KS , 66739, USA
Phone : +1 620-783-4441 $$$