Employment Application Form

1. Position Applying For *

Instructor

Business Development Manager (BDM)

Business Development Executive (BDE)

Human Resources (HR)

Receptionist

Attorney (Healthcare)

2. Personal Information

Email Address *

Phone Number *

Current Address:

3. Work Eligibility *

Are you legally eligible to work in the U.S.?

Yes

No

Will you now or in the future require sponsorship for an employment visa?

Yes

No

4. Availability *

Preferred Start Date:

Schedule Availability:

Full-time

Part-time

Evenings

Weekends

On-call/Flexible

5. Certifications & Licenses (if applicable)

Expiration Date:

Check all current certifications:

RN

Article 9

Prevention and Support

Positive Behavior Support

CPR and First Aid

BLS

ACLS

PALS

6. Education Background *

Highest Level of Education Completed:

High School Diploma / GED

Associate Degree

Bachelor’s Degree

Master’s Degree or Higher

7. Work Experience

(List your past three relevant jobs)

Years of Experience: *

Employer: Job Title: Employment Dates:

From:

To:

Duties & Responsibilities: Reason for Leaving:

8. References

Reference 1 (Professional Only) *

Name * Relationship *

Email *

Phone Number *

Address *

Reference 2 (Professional Only) *

Name * Relationship *

Email *

Phone Number *

Address *

Reference 3 (Personal Only)

Name Relationship

Email

Phone Number

Address

9. Upload Resume/CV *

Attach your file

Upload a File

Drag and drop files here

10. Additional Information (Optional)

11. Consent & Signature

I certify that the information provided is true and complete to the best of my knowledge. I authorize the investigation of all statements and references listed. I understand that misrepresentation or omission of facts may be grounds for termination.

I consent to receive SMS updates regarding my application status.

I hereby authorize Dignity Medical Training Institute, to conduct a background check, credit check, and drug test as part of the hiring process. I understand these checks may include verification of my criminal history, financial history, education, employment history, and drug screening, as permitted by applicable laws.

I acknowledge that these checks will be conducted in compliance with all federal, state, and local regulations, including the Fair Credit Reporting Act (FCRA). The results will be used solely to evaluate my suitability for employment with Dignity Medical Training Institute. I release Dignity Medical Training Institute and its agents from any liability related to these checks, to the extent permitted by law.

Applicant Signature (Draw your running signature) *

Date *