In order for your application to be processed, it is required that you fill in all entries, not just required fields. We will not be able to consider applications that are not completely and correctly filled out. In addition, each applicant MUST indicate specific “open position(s)” for which they are applying. Rogers Memorial Hospital is a smoke-free environment.

Your Contact Information

Position Desired

Please note: To be considered an applicant you must specify a current open position. You may also specify up to two additional positions you may be interested in.

Yes

No

Regular Full Time

Regular Part Time

Temporary

Pool

1st Shift

2nd Shift

3rd Shift

yes

no

yes

no

some

Brown Deer

Delafield

Kenosha

Madison

Oconomowoc

West Allis

Additional Information

yes

no

yes

no

yes

no

yes

no

yes

no

yes

no

Yes

No

Please note: Convictions are not an automatic bar to employment. Lack of disclosure may do so.

Yes

No

Yes

No

Yes

No

Yes

No

High School Information

1

2

3

4

Yes

No

College Information

1

2

3

4

Yes

No

Graduate School Information

1

2

3

4

Yes

No

Other School Information

1

2

3

4

Yes

No

For Professional Applicants Only

Yes

No

Please begin with your present or most recent employer

Full Time

Part Time

Pool

Employer #2

Full Time

Part Time

Pool

Employer #3

Full Time

Part Time

Pool

Yes

No

Terms of Application

The following sections must be read and acknowledged before any action will be taken by Rogers Memorial Hospital for employment consideration. If you have any questions regarding this application process, please contact the Human Resources Department via e-mail at hr@rogershospital.org

I certify that all the statements inclluded in this application and/or related documents are true and complete.

I understand that any misstatement or omission of fact on this application form and /or related documents shall be sufficient cause for denial of employment or summary dismissal at any time during employment.

I consent to investigation by Rogers Memorial Hospital, Inc., of all references and previous employers to secure additional information.

I release from any and all liability all representatives of Rogers Memorial Hospital, Inc., for their acts performed in good faith in connection with evaluating my application, credentials and qualifications.

I understand that my application will remain active for 30 days.

I understand that Rogers Memorial Hospital, Inc., operates 24 hours per day, 7 days per week, therefore, weekend work, work location and/or changes of shift may be required if I am employed.

I understand that if I am employed by the Hospital, my employment can be terminated by either the Hospital or myself at-will, with or without cause, and with or without notice, at any time.

I understand that any offer of employment is contingent upon the satisfactory completion of a post offer occupation-based physical examination and investigation of my work record and references.

- If I am extended and offer of employment, I hereby authorize Occupational Health Services at Oconomowoc Memorial Hospital to conduct a urine drug screening.

- I also authorize the release of the results of such screening to the Medical Review Officer and Rogers Memorial Hospital's Health and Wellness Coordinator and myself to ensure the confidentiality of this test.

- I understand that any offer of employment is contingent on the results of this exam.

- I also understand that if I test positive on the drug screening, I may request a re-test of the original sample at my expense. This authorization is effective for a period of one year.

- I also grant permission for Rogers Memorial to investigate my criminal / civil / ordinance history record, employment references, credentials, qualifications, and any statement I have made in this aplication or during the hiring process. I further release Rogers Memorial from any liability resulting from such investigation.

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