Employee Registration
HR Administrstion
Employee Downloads
Hello User!
EMPLOYEE DETAILS
POSITION(s) APPLIED FOR
*
DATE
*
FULL NAME
*
ADDRESS
*
PREVIOUS ADDRESS
PHONE
*
ALTERNATE/CELL
Email
*
AVAILABILITY
Date Available For Work
*
Salary Desired
*
$
Availability (Check all that apply)
FULL TIME
PART TIME
PER DIEM
OTHER
DAYS
NIGHTS
WEEKENDS
HOLIDAYS
Are you currently working?
Are you at least 18 years of age
Are you lawfully eligible to be employed in the United States? Proof of identity and/or eligibility status is required upon employment
PROFESSIONAL LICENSE/CERTIFICATIONS (Please complete all sections, and list N/A where needed)
License:
State
Exp. Date
Under Review?
License:
State
Exp. Date
Under Review?
BLS/CPR?
Expires
ACLS?
Expires
IV Certified?
Have you worked for LADMC before as either staff or contract/agency employee?
If yes, when?
Reason for leaving?
Have you ever worked under another name?
Do you have friends or relatives employed by LADMC?
If yes, name/location
How did you hear about Los Angeles Downtown Medical Center?
EMPLOYMENT HISTORY
NAME OF COMPANY
JOB TITLE
FROM: Month
Year
TO: Month
Year
ADDRESS
PHONE NO.
IMMEDIATE SUPERVISOR
DUTIES
REASON FOR LEAVING (Please Explain)
EXPLAIN ANY PERIOD BETWEEN
MAY WE CONTACT EMPLOYER?
Add EMPLOYER
Update EMPLOYER
#
EMPLOYER
JOB TITLE
FROM
TO
ACTION
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.
{{emp.compName}}
{{emp.jobTitle}}
{{emp.fromMonth}}/{{emp.fromYear}}
{{emp.toMonth}}/{{emp.toYear}}
EDIT
DELETE
EDUCATION
NAME, LOCATION & PHONE NUMBER
COURSE OF STUDY
NO. OF YEARS
DEGREE / DIPLOMA RECEIVED
PROOF OF EDUCATION ATTACHED
HIGH SCHOOL
COLLEGE / UNIVERSITY
VOCATIONAL OR TRADE SCHOOL
GRADUATE WORK
List any academic, professional, trade or job-related organizations that you are a member
OFFICE / COMPUTER SKILLS (Check the areas that you have skills and knowledge)
General Computer Knowledge
Beginner
Intermediate
Advanced
Microsoft Office
Beginner
Intermediate
Advanced
Excel Spreadsheets
Beginner
Intermediate
Advanced
Power Point Presentations
Beginner
Intermediate
Advanced
Email / Internet Research
Beginner
Intermediate
Advanced
General Office Equipment: (Fax, Photocopier, Telephone etc.)
Experience
No Experience
REFERENCES
NAME
OCCUPATION
COMPANY NAME
PHONE
1.
2.
3.
