Apply for a Position at P&S Surgical Hospital

Louisiana Center for Weight Loss Surgery

About Us Services Registration Career Center Contact Us

Careers at P&S

To The Applicant:

P&S Surgical Hospital will provide equal employment opportunity for all employees and applicants without prejudice in regard to race, color, religion, physical or mental impairment or medical condition, national origin, gender, age, or veteran status except where age, gender or physical status is a bonafide occupational qualification. P&S Surgical Hospital conducts pre-employment drug screening on all individuals following job offer.

Position Position Applied For:
Salary Desired: $
Daytime Phone: () -
Alternate Phone: () -
Referral Source:

Personal Name:
SSN: - - Address:

State:
Zip:
Phone: () -
Email:

Is there any reason you cannot perform the duties and responsibilities of the job during the next year?
No Yes

If yes, please explain.

Have you ever worked for P&S Surgical Hospital?
No Yes

Are you 18 years old or older?
No Yes

Do you have any relatives currently employed by P&S?
No Yes

Are you either a United States citizen or an alien who has the legal right to work in the job for which you are applying?
No Yes

Have you, since the age of 18, ever been convicted of a felony?
No Yes

If yes, please explain.

Education

High School:

Years completed:
School:
Address:
City:
State:
Zip:
Area of Study:
Date Completed:
Under Name of:

College:

Years completed:
School:
Address:
City:
State:
Zip:
Area of Study:
Degree:
Date:
Under Name of:

Graduate School:

Years completed:
School:
Address:
City:
State:
Zip:
Area of Study:
Degree:
Date:
Under Name of:

Non-Nursing Applicants School or Training:
Length of Program: years
City:
State:
Zip:
Date:
? Licenses:

List the registration number & expiration date of any professional, technical, or occupational license you hold.

Area of Study:
Words Per Minute: Typing:
Shorthand:
Medical Technology? Yes No

?Office Equipment:

List any office equipment you operate.

?Specialization / Interest:

Do you have any area of specialization or major interest?

Nursing Applicants Only

Check One if Applicable:

Registered
Licensed Practical Nurse
Other

Current License:

License Number:
State: Exp. Date:

Basic Nursing Program

Length of Program: years
Degree: Diploma A.D. B.S.
Date of Graduation:
School of Nursing:
Address:
City:
State:
Zip:

Advanced Nursing Preparation:

School of Nursing:
Dates: -
Major / Degree:
? Specialization / Interest:

Do you have any area of specialization or major interest?

Personal / Professional References

Give the name(s) of persons, not related to you, that we may contact to verify your qualifications for the position. New Graduates – please list professors or clinical instructors.

Reference 1

Name:
Occupation:
Organization:
Address:
City:
State:
Zip:
Phone: () -

Reference 2

Name:
Occupation:
Organization:
Address:
City:
State:
Zip:
Phone: () -

Employment

Most Recent

Name Used:
Date: From: To:
Employer:
Address:
City:
State:
Zip:
Salary: Starting: $ Ending: $
Employed:
Title:
Job Duties:
Supervisor:
Reason for Leaving:

May we contact this employer? Yes No

Phone: () -

2nd Most Recent

Name Used:
Date: From: To:
Employer:
Address:
City:
State:
Zip:
Salary: Starting: $ Ending: $
Employed:
Title:
Job Duties:
Supervisor:
Reason for Leaving:

May we contact this employer? Yes No

Phone: () -

3Rd Most Recent

Name Used:
Date: From: To:
Employer:
Address:
City:
State:
Zip:
Salary: Starting: $ Ending: $
Employed:
Title:
Job Duties:
Supervisor:
Reason for Leaving:

May we contact this employer? Yes No

Phone: () -

4TH Most Recent

Name Used:
Date: From: To:
Employer:
Address:
City:
State:
Zip:
Salary: Starting: $ Ending: $
Employed:
Title:
Job Duties:
Supervisor:
Reason for Leaving:

May we contact this employer? Yes No

Phone: () -
?

Briefly describe the type of work for which you are best qualified. Note any details about your qualifications which should be considered. Include special skills, machines operated, professional affiliations, honors and awards, publications, etc. You may omit those which indicate your race, religious creed, color, national origin, ancestry, sex, age, physical or mental impairment or medical condition, or veteran status.

Please Read

The following statements constitute conditions under which you would be employed by P&S Surgical Hospital:

The information that I have provided on this application is accurate to the best of my knowledge and subject to validation by P&S Surgical Hospital.

I authorize the persons, schools, law enforcement agencies, and other organizations or employers named in this application to provide P&S Surgical Hospital with any relevant information that may concern my employment with P&S Surgical Hospital.

I understand and agree that:

Any withholding of information or making false statements on this application or on P&S Surgical Hospital forms could result in rejection for employment or, if employed, termination from the Hospital.

Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift changes, a rotating work schedule or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

A medical examination and signed release statements as stipulated by the Hospital are required. Results will be held in confidence by the Employee Health Department except where release of such information is required by law.

All employees are on a trial basis during the first three months of employment.

Termination with or without cause and with or without notice, at any time, is an option of the Hospital.

I agree to abide by the policies, rules and regulations as set forth in the Hospital employees’ hand book (and as it may be revised).