Apply for a career at GPRMC | Great Plains Regional Medical Center, Elk City Ok

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Contact Info

First Name*

Last Name*

Alias

Phone*

Email*

Address*

City*

State*

Zip Code*

If less than 5 years at current address, please provide previous (full)address(es) and appropriate dates of residence.

Drivers License

Drivers License #

License State

License Exp

Legal Information

Have you used illegal or illicit drugs (or inhalants) within the last 30 days? *

Are you eligible to work in the U.S. on a full-time basis without restriction in accordance with the immigration reform and control act of 1986? *

Referral/References

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Licensure, Certification and Skills

Licensure, Certification And/Or Skills

Years

Education

High School*

City*

State*

Did you graduate?

Tech School/College

City

State

Degree/Major

Years Attended

GPA

Graduate?

Employment

Have you ever applied or been employed by GPRMC? *

Date Available*

Salary Desired (in dollars)

Shifts Available
Days Evenings Nights Weekends Mix

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Employment History (Begin with most recent experience and include complete employment history, either part-time or full-time. "See resume" is not acceptable)

Company Name

Company Address

Company City

Company State

Type of Business

Company Phone

Start Date

End Date

Position/Title

Status

Supervisor Name

Supervisor Title

Specific reason for leaving

Company Name

Company Address

Company City

Company State

Type of Business

Company Phone

Start Date

End Date

Position/Title

Status

Supervisor Name

Supervisor Title

Specific reason for leaving

Company Name

Company Address

Company City

Company State

Type of Business

Company Phone

Start Date

End Date

Position/Title

Status

Supervisor Name

Supervisor Title

Specific reason for leaving