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WE ARE AN EQUAL OPPORTUNITY EMPLOYER. All qualified applicants are considered for employment without regard to race, color, sex, age (40 and over), religion or national origin, disability, veteran or other protected status. St. Charles Parish Hospital is an equal opportunity employer. Click here to view the EEO is the Law poster:
Please complete all of the following information. This information will be used to determine your experience as it pertains to the position to which you have applied. Any fraudulent information on this form will constitute grounds for disqualification or dismissal.
In order for you to be considered for employment it is necessary for you to meet all the position's minimum qualifications.
Instructions to Applicant:
1. You must
fully and accurately complete the application for employment. Incomplete applications will not be considered. St. Charles Parish Hospital may use information given in the application to investigate an applicant's previous employment background.
The application for employment will be considered inactive after 90 days. If you wish to be considered after that time, you must complete a new application for employment.
3. If you are hired, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
It is the policy of this company to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, gender, marital status, religion, national origin, ancestry, or other protected classification.
Hold down the Ctrl key (Command key for Mac) to make multiple selections or to clear items. Mandatory fields are marked with an asterisk.
District of Columbia
Northern Mariana Islands
Newfoundland and Labrador
Prince Edward Island
Primary Phone #:
Lao Democratic Republic
Papua New Guinea
Saint Vincent Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
Alternate Phone #:
Minimum Annual Salary:
How did you hear about us?
Other (Please Specify)
Other (Specify Source):
To help us better know you and further assess your qualifications for this position, please answer the following questions as accurately as possible.
1. Are you at least 18 years of age?
18 years of age or older?:
2. Are you currently charged with a felony or misdemeanor criminal offense (other than a minor traffic violation) that has not yet been resolved? **
** Disclosure of a pending criminal charge does not automatically disqualify you from employment with St. Charles Parish Hospital. However, St. Charles Parish Hospital will conduct a criminal background check if you receive a conditional job offer and may rescind that job offer if you are dishonest in answering this question.
Felony or Misdemeanor:
If yes, please explain the circumstances of the pending criminal charge, including date(s), location(s), arresting agency(ies), court(s) involved and nature of the pending criminal charge(s).
Pending Charges Details:
3. Have you ever been convicted of a crime? Please note that this question seeks information about both felonies and misdemeanors, but does not require you to disclose minor traffic violations (e.g., speeding ticket, expired tag, etc.). A “conviction” includes any determination of guilt by judge or jury, guilty plea, plea of nolo contendere (no contest), payment of fine or forfeiture of bond. **
** Disclosure of a criminal conviction does not automatically disqualify you from employment with St. Charles Parish Hospital. However, St. Charles Parish Hospital will conduct a criminal background check if you receive a conditional job offer and may rescind that job offer if you are dishonest in answering this question.
Convicted of a Crime:
If Yes, please explain the circumstances of the conviction, including the date(s) of the conviction(s), the court(s) involved, the nature of the criminal conviction(s) and the sentence(s) that were imposed.
4. Are you legally authorized to work in the United States?
I am authorized to work in this country for any employer
I am authorized to work in this country for my present employer only
I require sponsorship to work in this country
My status to work in this country is unknown
5. Did you at any time before or are you currently completing clinical education in the St. Charles Parish Hospital or Ochsner System?
If Yes, in what specialty and/or program, and please indicate the approximate date and duration of the educational experience.
6. Have you ever been employed at St. Charles Parish Hospital or Ochsner or any of its affiliates?*
* This information will not be used to automatically disqualify you from consideration for employment; however, giving false information will.
If Yes, please give the dates of employment and the name under which you were employed.
This concludes the application information.
Voluntary Equal Opportunity Questionnaire
As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.
Choose Not to Disclose
Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaska Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)
Choose Not to Disclose
Voluntary Veterans Status
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
A “ disabled veteran” is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A “ recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “ active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “ Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL. If you believe you belong to any of the categories of protected veterans listed above, please indicate by making the appropriate selection below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. You can select all that apply by holding CTRL and clicking the appropriate selections. Any information provided is voluntary and will not be not be used in any fashion that is inconsistent with this act.
I am not a protected veteran
Recently Separated Veteran
Active Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
I am a protected veteran, but choose not to self-identify by classification
Choose Not to Disclose
Voluntary cc305 Form
Candidate Individual with disabilities:
Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.
i 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 form 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:
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the US. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.