Interested in joining our team? Please submit the short form below, and a Human Resource representative will contact you to complete the full application process.
Required fields are marked with *
Give a complete record of all employment and reasons for periods unemployed during the past ten years. Start with most recent employment.
Please list the names of three persons - who are NOT relatives or friends - we may contact to verify your qualifications for the position.
Please upload one additional document you would like included with your application. (e.g. Resume, Cover Letter, Reference, Licensure, etc.)
Signature for Authorization
In consideration of my employment, I agree to conform to the rules and regulations of this facility. I understand that my employment can be terminated at any time and for any reason, at the option of either the facility or myself. I understand that no one has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, except for a written employment agreement signed by an administrative representative of this facility.
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment may result in discharge even if discovered at a later date.
I hereby authorize persons, schools, my current employer (if applicable) and previous employers and organizations named in this application (and accompanying documentation, if any) to provide this facility and all affiliates with any relevant information regarding an employment decision, and I release all such persons from any liability regarding the provision or use of such information.
Background Check Authorization
I hereby authorize UnityPoint Health – Keokuk and/or its agents to make an independent investigation of my background, references, past employment, education, criminal or police records, including those maintained by both public and private organizations, and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with UnityPoint Health – Keokuk.
I release UnityPoint Health – Keokuk and/or its agent and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in regarding to the information obtained from any and all of the above referenced sources used.
The following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge.
Optional: Applicant Data Record
Qualified applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. As employers/government contractors, we comply with government regulations and affirmative action responsibilities. Solely, to help us comply with government record keeping, reporting and other legal requirements, please fill out the Data Record. This Data is for periodic government reporting and will be kept in a confidential file separate from the Application for employment.