Online Application-After completing the application and click on submit, you will be asked to verify your name. This must be done in order for TMC to retrieve the application.

Please provide the following contact information:

First Name
Last Name
Middle Initial
Mailing Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

 What position are you applying for?                                                                  

Hospital Nursing Home Clinic No Preference Quality Assurance/Utilization Review Housekeeping Maintenance CNA LPN RN Dietary Physical Therapy Radiology Business Office Provider Other

 

What shifts can you work? Day    Evening    Night    Full-Time    Part-Time

When you would be available to start?    mm/dd/yy

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

Yes No

Have you ever filed an application with TMC before?

Yes No

Have you previously been employed by TMC? If so, When?

Yes No   

Name of Schools attended, Highest Grade Completed, Major Courses, and Diploma or Degree received.

Do you have any specialized training or experience?

                Recent Employers                      Phone                         Position Held               Dates: From/To        Salary          Work Status          Reason For Leaving

Select One Full-Time Part-Time

Select One Full-Time Part-Time

Select One Full-Time Part-Time

 

May we Contact your Current Employer? Yes No             May we Contact your Previous Employer? Yes No

 

 

If Applicable:

North Dakota Registration Number:Expiration Date:

 

Other states you are registered in:Registration Numbers:

 

 

Has your license to practice in any jurisdiction ever been denied, terminated, limited, revoked, suspended, voluntarily or involuntarily surrendered, relinquished, or subjected to probationary terms, or is there a pending action or challenge to do so? Yes N/A No

 

Personal References: No Relatives

Name                                        Phone Number                                    Occupation

            

            

            

 

Have you ever been convicted for an act committed in violation of any State or Federal Law or Ordinance other than traffic offenses? No Yes
Criminal convictions are not an absolute ban to employment, but will be considered in relationship to specific job requirements.

 

Please Read and Initial Below:

I hereby acknowledge that this application does not constitute an employment contract and that any employment relationship with TMC is of an "at will" nature. It is further understood that this "at will" employment relationship may not be changed by any written documents or by conduct unless such change is specifically acknowledged in writing by an authorized executive of TMC. I certify that the statements on this form are true and complete to the best of my knowledge. During my employment, I agree to support all policies of TMC. I authorize investigation of all statements contained in this application. I agree that all former employers or any other persons may furnish TMC with all information regarding their record of my service, character, and reason for leaving. I hereby release such former employers and persons from all liability on account of providing such information. I understand that misrepresentation or omission of information in connection with application will be sufficient cause, in and of itself, for rejection or dismissal whenever discovered.

 

Initials of Applicant:        Date: