Employment Application

Please print or type. The application must be fully completed to be considered. Please complete each section, even if you attach a resume.

Weiss Hospital and West Suburban Medical provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, all of our hospitals comply with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Personal Information

Education Information

College, University, Technical or Vocational

Name and Location of School: Dates Attended: Major: Type of Degree: Graduated:

Please list most current employer first:

Employment History


Pre-Employment Statement:

Please read carefully, print name, sign, and date at the bottom

I understand and agree that:

I have reviewed this application carefully and I hereby affirm that my statements and answers to all questions on this application are true and correct and that I have not knowingly withheld any fact or circumstance that, if disclosed, would affect my application unfavorably. I understand that any misstatement or omission of fact on this application will result in my application not being considered, and if employed, may lead to disciplinary action up to and including termination.