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TEXAS HILLS URGENT CARE CENTERS Application for Employment

Texas Hills Urgent Care Centers is currently accepting creative and hard working applicants to fill a number of available positions.
To ensure proper consideration, please fill in the information below as completely and accurately as possible.

Personal Information

* First Name

* Last Name

* Position(s) applying for:

*

Full-time

Part-time

As Needed (PRN)

* Minumum Hourly Wage Requested

* I would like to work at:

Marble Falls @ 1701 HWY 281 N

Bee Cave @ 13917 HWY 71 W

Cedar Park @ 351 CYPRESS CREEK RD

* Address 1

Address 2

* City

* State

* Postal Code

* Home Phone

* Cell Phone

* Email Address

LICENSURE

Name of Licensing Board

State of Issue

License number

* Are you legally authorized to work in the United States?

Yes

No

* Have you ever been convicted of a felony?

Yes

No

If yes, please explain.

EDUCATION

* Please list all Education from High School, College, Trade School, and Graduate School and list any diplomas, Degrees, or certificates you hold from those institutions.

* Please check all that apply.

Availability

* Hours of availibility

Mornings

Afternoons

Evenings

Other

* Days Available

Employment History

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

Employer

Address

Phone

From (MM/YYYY)

To (MM/YYYY)

Position

Salary

Supervisor/Manager

Reason for Leaving

References

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

SKILLS

* Please list skills that would enable you to perform in the job your are applying for.

Additional Skills

Typing Speed (words per minute)

List any additional skills that you would like to mention.

Please submit a copy of your resume.

AUTHORIZATION TO RELEASE INFORMATION: I authorize the references and/or employers listed on my employment application, or any other documents I have provided to this Company, to give TEXAS HILLS URGENT CARE CENTERS any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing such information to this Company. I agree and understand that this Company and its agents may investigate or seek information concerning my background and/or previous employment, whether of record or not. I further agree and understand that if employed, TEXAS HILLS URGENT CARE CENTERS may at any time seek any information from whatever source, which in its discretion, it deems relevant to my employment. I also understand that any investigation or information sought regarding my previous employment or consumer records may not be completed or in possession of this Company and thus my continued employment may be affected by such information once received. I hereby acknowledge, confirm, convey, agree and grant this Company’s right to act on any additional information received including, at TEXAS HILLS URGENT CARE CENTER’s sole discretion, termination of my employment.

NO DRUG USE POLICY: This Company does not hire persons who use illegal drugs. All persons seeking employment or employed with this Company may be required to take and pass a screen for illegal drugs, and may be subject to periodic tests for illegal drugs. I hereby voluntarily consent to provide a urine specimen (or blood specimen as required for alcohol testing only) at a collection facility designated by this Company, and further consent to have the specimen tested at a laboratory selected by this Company.

*

I agree and accept the above that Texas Hills Urgent Care Centers does pre-employment drug testing, background checks, and that references and previous employers may be contacted.

* Indicates Response Required