JOIN OUR TEAM AND MAKE A DIFFERENCE EVERY DAY.

Learn more about what it means to be a part of our mission.

If you are interested in employment for future opportunities, please submit a completed application below and email your CV, if applicable, to mmiles@echochc.org.

If you are unable to apply online, please download an application here and email it to the address listed above.

APPLICATION FOR EMPLOYMENT

ECHO Community Health Care, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration without discrimination because of sex, race, color, religion, creed, national origin, or the presence of disabilities.

Date *

Date

YYYY

Position Applying For: *

Name *

Name

First Name

Last Name

Present Address *

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Email *

Are You Age 18 Or Older? *

Are you a US Citizen? *

Do you have a current & valid driver’s license? *

Have You Ever Been Convicted Of A Crime That Has Not Been Expunged By A Court Of Law? *

If Yes, Please Explain

EDUCATION AND TRAINING (Complete As Appropriate)

High School (Name, Address) *

College Or University (Name, Address, Major, Degree) *

Graduate School (Name, Address, Major, Degree) *

Technical Or Vocational (Name, Address, Certificate) *

PROFESSIONAL LICENSURE OF CERTIFICATION (Complete As Appropriate)

Type Of License Or Registration, ID Number, Issue Date, Expiration Date, State

Technical And Professional Job Related Memberships:

EMPLOYMENT (List all employment, starting with present or most recent position.)

Present Or Last Employer

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

May We Contact?

Dates Of Employment

Job Title

Nature Of Work And Responsibilities

Starting Salary

Last Salary

Reason For Leaving

Next Previous Employer

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

May We Contact?

Dates Of Employment

Job Title

Nature Of Work And Responsibilities

Starting Salary

Last Salary

Reason For Leaving

Next Previous Employer

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

May We Contact?

Dates Of Employment

Job Title

Nature Of Work And Responsibilities

Starting Salary

Last Salary

Reason For Leaving

Next Previous Employer

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor's Name

May We Contact?

Dates Of Employment

Job Title

Nature Of Work And Responsibilities

Starting Salary

Last Salary

Reason For Leaving

Please Explain Any Gaps In Your Employment History *

Do You Have Any Relatives Employed at ECHO Community Healthcare? *

If Yes, List Names And Relationships

VOLUNTARY INFORMATION

Invitation To Self Identify

Anti-Discrimination Notice. It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, sex, or national origin. This employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, this employer invites applicants and employees to voluntarily self-identify their race/ethnicity and gender. Submission of this information is voluntary, and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

What Is Your Gender?

What Is Your Ethnicity?

Voluntary Self-Identification of Disability

Why are you being asked? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this part is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness, Deafness, Cancer, Diabetes, Epilepsy, Autism, Cerebral Palsy, HIV/AIDS, Schizophrenia, Muscular Dystrophy, Bipolar Disorder, Major Depression, Multiple Sclerosis, Missing Limbs or Partially Missing Limbs, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder, Impairments Requiring The Use Of A Wheelchair, Intellectual Disability (Previously Called Mental Retardation)

Please Select One

NOTICE: READ CAREFULLY AND SIGN

I voluntarily authorize ECHO Community Health Care (ECHC) to make a thorough pre-employment investigation. I hereby authorize former and present employers, except as otherwise indicated on this application, and others to provide or verify any information they have regarding me or my employment and release them from any liability for furnishing such information to ECHC. I understand that employment is contingent upon satisfactory investigation of references. All information in this application and employment related documents are true and complete. I understand that if I am employed, false statements on this application and employment related documents shall be considered sufficient cause for dismissal. Upon an offer of employment, I agree to have a medical evaluation and understand that my employment is contingent upon passing the evaluation. I agree to take such future medical evaluation as may be required by ECHC. I understand that my employment and compensation can be terminated with or without cause and with or without notice at any time at the option of the ECHC Board of Directors. If employed, I agree to abide by the policies, procedures, and rules of ECHC. I further agree to protect the confidentiality and privacy of any information regarding ECHC patients.

PLEASE TYPE NAME FOR SIGNATURE *

DATE OF SIGNATURE *

DATE OF SIGNATURE

YYYY

VIEW ALL CURRENTLY AVAILABLE POSITIONS

CLINICAL EXPERIENCE FOR STUDENTS.

ECHO is an approved NHSC site. This is not a direct benefit of ECHO.

AFTER HOURS / ON CALL

812-421-7489

Learn more about what it means to be a part of our mission.

VIEW ALL CURRENTLY AVAILABLE POSITIONS

CLINICAL EXPERIENCE FOR STUDENTS.

VISIT NHSC.HRSA.GOV