Job Application

Come Work With Us at Healthcare at Foster Creek!

Interested in working at Foster Creek? Please fill out and submit the following application. Please note that you cannot save and come back to finish it, so be sure you have time to complete the application completely before you start.

If you’d prefer, you can print out a Job Application and submit it by mail or in person Monday – Friday 8:00am – 4:00pm at 6003 SE 136th Ave., Portland, OR 97236

Applicant Information
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Referred by:
Do you have a valid driver's license
- Yes
- No
Driver's license number
Are you a citizen of the United States?
- Yes
- No
If no, are you authorized to work in the U.S.
- Yes
- No
If you are hired can you provide proof that you are authorized to work in the US?
- Yes
- No
Have you ever worked for this company?
- Yes
- No
If so, when?
Desired Position
Position Title Applying For
If not applying for a specific position, please indicate your desired position preferences in the questions below.
Desired Salary/Wage
Shift Desired
please check any you're interested in
- Day
- Evening
- Night
Employment Desired
please check any you're interested in
- Full Time
- Part Time
- Temporary or Seasonal
How many hours/week are you available?
Date Available to Start Work
Is there any type of work which you will not perform?
- Yes
- No
If yes, explain
Education
High School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
College
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree
Other
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree
Please list any licenses or certificates that are job related:
Previous Employment
Company
Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Job Title
Responsibilities
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Reason for leaving
Company
Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Job Title
Responsibilities
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Reason for leaving
Company
Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Job Title
Responsibilities
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Reason for leaving
Work History
If you worked in any of your previous positions under another name, please give that name(s)
May we contact your current employer?
- Yes
- No
If no, please explain
How many days of work or school have you missed in the last two years?
Have you ever been asked to resign from a job?
- Yes
- No
If yes, please explain
Military Service
Branch
From - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
To - must be mm/dd/yyyy format
Date Format: MM slash DD slash YYYY
Rank at Discharge
Type of Discharge
Training, duties, or experience
References
Please list three professional references
Name
First Last
Relationship
Company
Phone
Email
Name
First Last
Relationship
Company
Phone
Email
Name
First Last
Relationship
Company
Phone
Email
Resume
upload your resume here (optional)
Accepted file types: doc, pdf, jpg, png, docx, doc.
Disclaimer & Signature
I certify that my answers are true and without any consequential omissions of any kind. I understand that if I am employed, any false misleading or otherwise incorrect statements made on this application form or during any interviews will be cause for my immediate dismissal. I hereby authorize the Company to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for libel, slander, defamation, invasion of privacy, or any other reason because of their statements. If employed, I agree to comply with its rules and regulations. I understand that I will also be required to complete a Criminal Background Check and Fingerprint Check before I can be employed. Once employed by this facility I will be on a 90 day evaluation period. I further understand that if I am employed, this company also reserves the right to subject me to a drug and alcohol testing to the extent required or permitted by applicable law. I understand that if hired, I will be an “at will” employee and agree that the employment relationship can be terminated at any time and for any reason by me or this company.
By typing my name here I agree I have read and understand the above disclaimer * Required
Date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY

We are an equal opportunity employer and will consider all applicants for all positions equally. Our company is dedicated to a policy of nondiscrimination and will consider all applicants for all positions equally without regard to race, color, sex, sexual orientation, marital status, religion, veteran status, genetic information, age, citizenship status, or any disability as defined in the Americans with Disabilities Act, or for any other reason protected by State or Federal law. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job-related factors. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. Any person needing reasonable accommodation in the application process should contact the Human Resource Manager.

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