Resumes and applications are accepted for positions at Bryan, Montpelier, and Archbold. Please complete the application below, or print by clicking here:  Application for Employment.
Return the completed application to:
Human Resources, CHWC,
433 West High,
Bryan, Ohio 43506

Note: Resumes stay on file for six months. Thank you.


Job Title - Click here to view full listing of available jobs.

Are you currently a CHWC employee?

Department

Location

Employee #
PERSONAL INFORMATION
Name (Last, First, Middle):
List other last names used (Maiden/Prior Married):
Present Address: Permanent Address:
City, State, Zip: City, State, Zip:
Are you 18 years or older?
Have you ever been convicted of a crime other than
minor traffic violations involving a fine of $300
or less? If yes, please describe in full.
Have you ever been excluded from participation in any
federal health care program?
If yes, state date of reinstatement and provide copy of letter or documentation from OIG announcing the
reinstatement.
EMPLOYMENT DESIRED
Date you can start:
Do you want to work full or part time?
Are you employed now?
If so may we inquire of your present employer?
Have you applied to CHWC before?
If so, when?

EDUCATION
Grammar School

Name and Location of School

Years Attended

Did You Graduate

Subjects Studied

High School

Name and Location of School

Years Attended

Did You Graduate

Subjects Studied

College

Name and Location of School

Years Attended

Did You Graduate

Subjects Studied

Trade, Business or Correspondence School

Name and Location of School

Years Attended

Did You Graduate

Subjects Studied

PROFESSIONAL LICENSE/REGISTRATION

License Registration Number

State Registered In

Registration Effective Date

Expiration Date


EMPLOYMENT HISTORY
List below all present and past employment, beginning with your most recent.
(NOTE: If you previously worked under another name,please indicate.)
Name and Address
of Company & Phone Number
Dates
From Mo/Yr To Mo/Yr
Position Salary Reason for Leaving Supervisor

IF YOU HAVE HAD NO PAST EMPLOYMENT

REFERENCES:

GIVE THE NAMES OF TWO PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

Name Address & Phone Number Business Years Acquainted

In Case of Emergency Notify:

Name Address Phone Number

Are you willing and able to travel between all CHWC facilities as needed?

Are you able to commit to the primary designated hours/schedule as listed in the posting?

Are you able to perform the essential job duties as listed in the posting?

Explain your interest in this position and what you feel qualifies you for this job posting

Preferred Contact Method

Best day of the week and time to contact?

Telephone

Email

Attach Files (cover letter, resume)

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application or any other hospital document shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment relationship with CHWC will be at-will. Thus, just as I am free to end my employment with CHWC at any time for any reason, CHWC may, at any time, end my employment with CHWC at its sole discretion. I acknowledge that no supervisor, manager, or representative of CHWC, now or in the future, has authority to enter into any agreement with me for employment for any specific period of time or to make any promise or commitment contrary to the foregoing, unless that alteration or agreement is set forth in writing and is signed by CHWC’s President.

I agree that any claim or lawsuit relating to my employment or application for employment with CHWC or any of its subsidiaries or affiliates must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.