CredentialsOnLine Job Application

Centralized Provider Verification Service

Corporate

History

Careers

Press/News

Map/Directions

HealthLine Systems' is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief, disability, and any other legally protected status.

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

E-mail:

Desired Position:

View Job Descriptions

If Other:

Interested in:

Full-time Part-time Other

Salary Desired:

How were you referred?

Employment History
Please list chronologically, beginning with most recent experience.

Employer:

Address/City:

From (MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Job Title:

Job Duties:

Reason for Leaving:

Employer:

Address/City:

From (MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Job Title:

Job Duties:

Reason for Leaving:

Employer:

Address/City:

From MM/YYYY):

To (MM/YYYY):

Supervisor:

Phone:

Salary:

Job Title:

Job Duties:

Reason for Leaving:

Education:

Name & Location of School	Select Last Year Completed	Major Course	Diploma/Degree
High School
College/University
College/University
Business or Trade School

Personal Information:

Are you legally authorized to work in the U.S.?: (If hired, you will be required to provide proof of work authorization.)

Yes No

Are you over 18 years of age?

Yes No

Have you been convicted of a crime in the past 7 years, excluding misdemeanors, which has not been annulled, expunged or sealed by a court?

Yes No

If "Yes", please describe in full:

List any certificates earned or in progress, and/or any additional training programs not included in your formal education, or any special skills.

List any Professional Affiliations to which you belong:

Are you presently employed?:

Yes No

If so, may we contact your present employer?:

Yes No

If hired, when would you be available?:

Are you able to perform the essential requirements of the job?

Yes No

If no, are there reasonable accommodations that can be made to allow you to perform the essential functions of the job?

Employment References:
List individuals familiar with your job qualifications (No relatives or personal friends).

1) Name of Reference:

2) Name of Reference:

Occupation:

Address:

City/State/Zip:

Phone:

Relationship:

How long known:

In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me with previous employers, schools, criminal convictions, and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release and agree to hold harmless all parties from all liability with regard to furnishing information to HealthLine Systems. I hereby give my consent for HealthLine Systems and/or any of their agents to obtain the above information. This authorization and consent shall be valid in original, fax, or copy form. I agree to release and hold harmless HealthLine Systems from all liability with respect to the receipt of such information.

All hiring and employment at HealthLine Systems is at-will. I understand that acceptance of an offer of employment does not create a contractual obligation upon HealthLine Systems to continue to employ me in the future. Employment by HealthLine Systems has no specific term and may be terminated by the employee or HealthLine Systems with or without notice.

I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with HealthLine Systems, and that failure to provide this evidence will result in the termination of my employment.

I certify that the information I have furnished on this application form is true and complete. I understand that if any misrepresentation has been made by me verbally or in writing, any offer of employment made to me may be withdrawn or my subsequent employment with HealthLine Systems may be terminated.

HealthLine Systems Website Links Page