Apply Online Step 1 - Personal DataPosition Applying ForSelect a PositionSurgery RNRespiratory TherapistPharmacistQuality Improvement & Education DirectorLAB TECH (MT OR MLT)Future Applicable OpeningsDate of ApplicationLast Name*First Name*Middle InitialAddress*City*State*Zip*Phone*Email* Are you 18 years of age or older?*YesNoAre you a U.S. citizen?YesNoHave you ever been employed at DCH before?YesNoIf yes, whenWhereDo you have a record of founded child or dependent adult abuse or have you even been convicted of a crime, in this state or any state?*YesNoI understand a pre-employment criminal history and child or dependent abuse record check will be performed.* I Agree Step 2 - EmploymentAvailability DateAre you interested in working* Full Time Part Time PRN What shift are you willing to work* Days Nights Any Step 3 - EducationList of Diploma or CoursesLast High SchoolDid you GraduateYesNoNameCollege or UniversityDid you GraduateYesNoNameOther Vocational or TradeDid you GraduateYesNoNameSpecial TrainingDid you GraduateYesNoName Step 4 - Professional DataList Registrations, Certifications and/or License Numbers and Dates Received*If Registration, Certification and/or Licenses are pending, when do you expect to obtain? Step 5 - Employment History List all employment beginning with your current or most recent past employerName of Employer #1*Position Title*Dates EmployedFromToAddress*Duties*Name of Supervisor*Phone*May we contact this employer?YesNoHourly Starting Salary*Hourly Ending Salary*Reason for Leaving*Name of Employer #2Position TitleDates EmployedFromToAddressDutiesName of SupervisorPhoneMay we contact this employer?YesNoHourly Starting Salary*Hourly Ending Salary*Reason for LeavingName of Employer #3Position TitleDates EmployedFromToAddressDutiesName of SupervisorPhoneMay we contact this employer?YesNoHourly Starting Salary*Hourly Ending Salary*Reason for Leaving Step 6 - Statement of HealthCan you perform the essential functions of the positions for which you are applying?YesNoIf no, explain Step 7 - Military DataVeteran?YesNoWhat type of training or experience did you receive in the service?Date of ServicesFromToBranch of ServiceFinal RankType of DischargeReserve StatusPlease list references below*How were you referred to DCH?* Step 8 - Signature and Authorization - Important, Please Read!I certify that information in the application is correct to the best of my knowledge.* I have read and agree to the above statement. Step 9 - ResumeUpload Your ResumeAccepted file types: doc, docx, pdf, txt.