Dedicated to providing quality health care for residents of Wayne County and surrounding areas of Southeast Mississippi and Southwest Alabama

Wayne General Job Application

Persons interested in employment with Wayne General Hospital may complete the application below. This information will be kept on file in the Human Resources Department. Your application will remain active for three months, after that you may reapply or email

Information obtained on this application will be kept confidential. It is intended to help reach parties interested in employment opportunities at Wayne General Hospital. The hospital will conduct interviews and may verify all information obtained on this application prior to an offer of employment.

* - Indicates a required field

Name*

Work Phone

Home Phone*

E-mail

Address*

City*

State*

Mississippi Alabama Louisiana

Position Desired- Ex. RN, LPN, Clerk, CNA, or etc.*

Current Employer

Reason for desiring change?

Why do you choose Hospital work?

What prompted you to apply here for employment?

Are you related to anyone in our Employ? Who and How?

Professional License Numbers, Type, and State or "NONE" if not applicable

Please list Schools and Colleges, Major Subject, Did you Graduate?, College Degree, and Attendance (From-To)*

Former Employers and Experience-Name, Address, Nature of Experience, Period (From-To), Salary, Reason for leaving

Former Employers

Former Employer

Address

Period Employed

Nature of Experience

Salary

Reason for Leaving

Former Employers

Former Employer

Address

Period Employed

Nature of Experience

Salary

Reason for Leaving

Former Employers

Former Employer

Address

Period Employed

Nature of Experience

Salary

Reason for Leaving

List at least 3 Personal References (not relatives)- Name, Address, Phone, Relationship

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, or on the basis of age or physical or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination.

I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the preemployment physical examination, and such future physical examinations as may be required by this institution at such times and places as the institution shall designate.

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.

If you agree with the above statements please proceed by submitting your application.