Marathon Healthcare

About Marathon

Introduction

Secure Investor Area

"Walking into this place when you first come in you know you're going to like it by the way you're greeted. "

About Marathon Healthcare Group

Employment Application

Marathon Healthcare Group provides equal employment opportunities without regard to race, color, sex , religion, national origin, handicap, age, disability, or any other reason protected by law.

Please read carefully; answer all questions; If any additional space is required, use the comment box at the end of the form. If you are unable to use a computer, or have trouble using this form, you can request a paper-based application from any of the Marathon Healthcare locations. Management and Professional applicants must also send a resume.

Personal First Name Last Name Middle Initial Social Security #

Home Address City, State & Zip Home Phone Mobile Phone

I am 16 years old or younger I can submit a work permit

I have been convicted of a crime involving the abuse, neglect or mistreatment of an individual or an other felony or misdemeanor (except routine traffic violations). I understand that a conviction will not necessarily diqualify me. Please list your offense(s) Date(s) Place(s) Disposition(s)

I learned of this opening by

Job Interest Position(s) Desired Dates Available Salary Required I am available for FULL time employment. I am available for PART time employment. I am available for day shifts. I am available for evening shifts. I am available for night shifts. I am available for weekend shifts.

Education Grade/High School completed
Last High School

Years of college

Name and location of College Major Degree Year Graduated Last College or Nursing School Courses you are currently taking

Professional Licenses/Certifications License Type State Date Issued Expires On Number

Additional License Type State Date Issued Expires On Number

List job related organizations, clubs, professional societies or other associateions to which you belong (you may omit those which indicate your rate, religion, creed, color, national origin, ancestry, sex, age, or handicap).

Skills Typing Speed Shorthand Speed Computer Dictaphone PBX Medical Term

This employer is subject to section 503 & 504 of the Rehabilitation Act of 1973. If you have a handicap, are a disabled veteran or veteran of the Vietnam era, and would like to be considered under our Affirmative Action program, please tell us. Information is voluntary and will be kept in confidence. Call Director of Human Resources of the Administrator.

Work Experience

Current or Latest Employer You may contact my present employer. Employer Employed From (mm/dd/yyyy) to (mm/dd/yyyy) Address City, State & Zip Phone

Starting Salary Final Salary

Supervisor's Name & Title Person(s) we may contact for reference

Your duties Reason for leaving

Additional Employer Employer Employed From (mm/dd/yyyy) to (mm/dd/yyyy) Address City, State & Zip Phone

Starting Salary Final Salary

Supervisor's Name & Title Person(s) we may contact for reference

Your duties Reason for leaving

Work Experience (continued)

Additional Employer Employer Employed From (mm/dd/yyyy) to (mm/dd/yyyy) Address City, State & Zip Phone

Starting Salary Final Salary

Supervisor's Name & Title Person(s) we may contact for reference

Your duties Reason for leaving

References (not related) Name Address Phone

Name Address Phone

Additional Comments

Please share any additional comments, or information that you were not able to include in the above form.

Please read the following carefully:

I authorize investigation of all statements contained in this application form if I am considered for employment. I also authorize previous employers names, or any other person or person to whom Marathon Healthcare Center, LLC my contact, to give any and all information regarding my emplyment hisstory with any other pertinent information. In addition, by submitting this application, I declare that the information contained on this application is true and correct.