Job Opportunities Current Positions Available: [No current listings] Even if no positions are currently advertised as available, you may send us your application to have on file for future opportunities. Please fill out the application below in its entirety. Please submit only one form per applicant. We will review your information and contact you based on availability. If you prefer, you may print This Form and email it to scfwjobs@starkvilleclinicforwomen.com Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Work Availability Date Available * MM DD YYYY Are you a Citizen of the U.S.? * Yes No If so, are you allowed to work in the U.S.? Yes No Have you ever been convicted of a felony? * Yes No If yes, explain: High School Education High School Name * Diploma Yes No College Education College Name Did you graduate? Yes No Degree Other Education Other Education Did you graduate? Yes No Degree Previous Employment Company * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Name * First Name Last Name Job Title * Responsibilities * From * MM DD YYYY To * MM DD YYYY Reason For Leaving * May we contact your supervisor for a reference? * Yes No 2nd Previous Employment Company Name * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor Name * First Name Last Name Job Title * Responsibilities * From * MM DD YYYY To * MM DD YYYY Reason For Leaving * May we contact your supervisor for a reference? * Yes No 3rd Previous Employment Company Name Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Supervisor First Name Last Name Job Title Responsibilities From MM DD YYYY To MM DD YYYY Reason For Leaving May we contact your supervisor for a reference? Yes No SKILLS Please list technical skills, clerical skills, trade skills, etc. which may be relevant to the position for which you are applying: * I certify that my answers are true and complete to the best of my knowledge. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Starkville Clinic for Women to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Starkville Clinic for Women serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason. Other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the U.S., to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first 90 days of regular employment represent a provisional period, during which I would not be eligible to apply for company benefits or transfer departments. * Yes No Starkville 100 Medical Park Dr. Starkville, MS 39759 Monday-Friday : 8am–5pm Info/Appointments: (662) 323-4427 Accounts/Billing: (662) 324-4205 Hosted and Maintained by MainStream Technologies, Inc. dba Starkville Computers Designed in collaboration with Sparrow Ink Design ©2017