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Employment Application

All qualified applicants will receive consideration for employment regardless of race, color religion, sex, age, sexual orientation, national origin or disability.

All offers of employment are contingent on a successful criminal background check, reference check, education verification, and passing an employee drug screen.

Correct Health is a certified drug-free workplace and will conduct pre-employment substance abuse testing.

Name
Last First Middle
Address
Number Street City State Zip
Telephone Cell Phone Email Address

Are you currently employed?   Yes    No

Are you currently working for another Correctional Company?   Yes    No

If yes, Company and Location:

Position for which I'm applying:

Full Time    Part Time    PRN    Any Status

Days    Nights    Any Shift

Can you travel if a job requires it?   Yes    No
Do you have a valid drivers license?   Yes    No

Have you ever been arrested?   Yes    No
If YES, please explain in detail:

Have you ever been convicted of a felony or misdemeanor where disposition was a conviction, a plea of nolo contendere (no contest), or first offender treatment?   Yes    No
If YES, please explain in detail:

Have you ever had a professional license revoked, reviewed, suspended or limited in any way?
Yes    No
If YES, please explain in detail:

Have you ever been dismissed or asked to resign from any job?   Yes    No
If YES, please explain in detail:

Please provide the name, address and telephone number of three professional references (Note, lack of current information will slow and/or eliminate the employment process).

Name Company Address Phone Number Relationship
Name Company Address Phone Number Relationship
Name Company Address Phone Number Relationship

Employment Experience

Please list beginning with your present or most recent job. Include military service assignment and volunteer activities.

Note: YOU MAY NOT SUBMIT A RESUME IN LIEU OF COMPLETING THIS WORK HISTORY

1. Employer
 Work Performed
Address
Job Title
Reason for Leaving
Dates Employed:   From    To
2. Employer
 Work Performed
Address
Job Title
Reason for Leaving
Dates Employed:   From    To
3. Employer
 Work Performed
Address
Job Title
Reason for Leaving
Dates Employed:   From    To

Special Skills, Licenses, Registration or Certifications and any Qualifications (including language skills, typing skills, and business equipment or machine operating skills) We only accept CPR/BLS/ACLS from the American Heart Association.

Areas of your position(s) which you have liked most and why:

Areas of your position(s) which you have liked least and why:

Education

High School
School Name
Address
City, State Zip

Years Completed
Diploma/Degree
Describe Course
of Study
Describe specialized
training, skills
extra-curricular
activities
College/University
School Name
Address
City, State Zip

Years Completed
Diploma/Degree
Describe Course
of Study
Describe specialized
training, skills
extra-curricular
activities
Graduate/Professional
School Name
Address
City, State Zip

Years Completed
Diploma/Degree
Describe Course
of Study
Describe specialized
training, skills
extra-curricular
activities
EMT/Paramedic Nursing School
School Name
Address
City, State Zip

Years Completed
Diploma/Degree
Describe Course
of Study
Describe specialized
training, skills
extra-curricular
activities

Optional Resume Upload

  


APPLICANT'S CERTIFICATION AND AGREEMENT

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered a sufficient cause for dismissal. CorrectHealth is hereby authorized to make any investigation of my prior educational work and criminal histories. By submitting this application I indicate an understanding that my ability to work is contingent on security clearance at the designated facility.

AUTHORIZATION TO RELEASE INFORMATION

I have completed and application for employment with CorrectHealth. I authorize my former employers to give any information regarding my employment and/or answer any questions regarding my employment. I hereby release them from any damages whatsoever for issuing the same.

May we contact your present employer?   Yes    No

By submitting this form you are authorizing us to confirm information and contact prior employers, even though we may not contact your present employer.