Employment Application

We're looking forward to learning more about you

Employment Application

Please read carefully.


Application must be filled out completely to be considered for the position you are applying for.

Applications and resumes are accepted for positions currently available.  Open Door Health Centers are committed to afford all qualified individuals an equal opportunity to pursue employment and advancement opportunities.   There shall be no discrimination against any person or group based upon race, color, religion, sexual orientation, national origin, sex, age, disability, or veteran status.

Employees of Open Door please ask your Supervisor or Human Resources for an Internal Application.  Please do not submit an online application.

General Information

Employment Interests

Any applicant with a disability who needs reasonable accommodation in any step of the hiring process or to assist him/her in demonstrating his/her qualifications to perform the essential functions of the job for which the applicant is applying should inform the Human Resources Director.
If yes, please state location, dates, and position held
Reason for leaving

Education and Skills

Name
City
State
Major Subject
Degree/Diploma
Name
City
State
Major Subject
Degree/Diploma
Name
City
State
Major Subject
Degree/Diploma
Name
City
State
Major Subject
Degree/Diploma

Spoken Languages

Language
Skill Level
Language
Skill Level
Language
Skill Level

Military Service

Employment History

Beginning with your present or last position, complete for ten years of employment. If you do not know the exact date that your employment started or ended, please choose the first day of that month.
Name
Supervisor
Wage/salary
Address
City
State
Phone
From
To
Position held
Reason for leaving
Duties

Name
Supervisor
Wage/salary
Address
City
State
Phone
From
To
Position held
Reason for leaving
Duties

Name
Supervisor
Wage/salary
Address
City
State
Phone
From
To
Position held
Reason for leaving
Duties

Name
Supervisor
Wage/salary
Address
City
State
Phone
From
To
Position held
Reason for leaving
Duties

Name
Supervisor
Wage/salary
Address
City
State
Phone
From
To
Position held
Reason for leaving
Duties

Professional References

List three people who are qualified to evaluate your employment performance, preferable supervisors, do not include relatives.
Name
Occupation
Years known
Address
City
State
Phone

email address
Name
Occupation
Years known
Address
City
State
Phone

email address
Name
Occupation
Years known
Address
City
State
Phone
email address

Upload Files


Upload your resume (accepted formats are pdf, doc, docx, txt & odf)

Upload other docs (Professional licenses etc...)

Authorizations and Signature

Please read and check off the following statements carefully before submitting this application.
All persons, upon hiring, must provide valid authorization to work in the United States.
If yes, please describe briefly (conviction will not necessarily disqualify you from employment)
Signature