Job Openings >> RN >> Apply
Apply for RN

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:RN
ID:13189
Location:Salem, Ohio
Department:Nursing/Tower 3 (Med/Surg Unit)
Job Type:SRMC
Resume
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Application Information
Referred By:
Opt-In Confirmation
I authorize recruiters from Salem Regional Medical Center to send text messages from 8669349271 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment
Statement to applicant
Salem Regional Medical Center (“Medical Center”) is pleased that you have chosen to apply for employment with Salem Regional Medical Center. Before completing this application, please read and carefully consider the following statements regarding Salem Regional Medical Center’s employment policy:
*Affirmative Action/Equal Opportunity Employer: Job applicants and employees shall not be discriminated against based on their race, color, religion, sex, age, national origin, citizenship, creed, sexual orientation, genetic information, marital status, physical disability, mental disability, ancestry, or veteran status. The Medical Center hires based on job-related qualifications, work experience, and references.
*At-Will Employment Policy: Salem Regional Medical Center is an at-will employer. If you are hired, you will be free to leave Salem Regional Medical Center’s employment at any time for any reason. Correspondingly, while Salem Regional Medical Center hopes to have a long and productive work relationship with its associates, it reserves the right to separate an associate from its workforce without notice at any time.
*Drug Free Work Environment: Because of Salem Regional Medical Center’s role as a health care provider, Salem Regional Medical Center places an extremely high priority on keeping its workplace totally free of all illegal drugs. Accordingly, Salem Regional Medical Center requires that all applicants, as a condition of employment, take and pass a screening test for illegal drugs. This test will be confidentially administered.
Salem Regional Medical Center will immediately terminate its consideration of any applicant who attempts to adulterate test results or who fails the test. Salem Regional Medical Center also reserves the right to test current employees for illegal drugs or alcohol if Salem Regional Medical Center finds reasonable cause to suspect substance abuse. A complete description of Salem Regional Medical Center’s testing procedures can be found in Salem Regional Medical Center’s Substance Abuse Testing Policy and Procedure, which will be made available to you.
*Smoke Free Work Environment: Salem Regional Medical Center is a smoke free, vape free, and nicotine free facility. These products are strictly prohibited on all campuses.
*Vaccination(s): Salem Regional Medical Center is committed to the health and safety of its patients and employees. The Medical Center complies with all federal and state laws related to immunizations. The Medical Center determines if vaccinations are considered job related and necessary for business operations.
If you can not comply with these policies, then you should not pursue employment with Salem Regional Medical Center.
Personal information
Yes   No
Education
Yes   No
Yes   No
Yes   No
Yes   No
Employment History
Yes   No
Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.

Current or Most Recent Employer

Previous Employer

Next Previous Employer

Next Previous Employer

Next Previous Employer

Next Previous Employer
References (Must include two professional)
*
*
*
*
*
*
*
*
*
Statement of availability
  
  
  
  
  
  
  
  
  
  
  
  
Yes   No
Yes   No
General information
Please be advised that ALL Salem Regional Medical Center campuses are nicotine, vape, and smoke free.
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Effective January 27, 1997, Senate Bill 160 requires employers to conduct criminal background checks of applicants under final consideration for employment in health care facilities. There is a fee for this service of which Salem Regional Medical Center will pay half (50%) and you, the applicant, will be responsible for the other half (50%) via payroll withholding. In addition, employment would be conditional upon satisfactory passing of the background check.
Yes   No
Professional or Technical information
RN   LPN   Other   None
Yes   No
Educational authorization
High School
I request a transcript to be sent to the Human Resources Manager, Salem Regional Medical Center, 1995 East State Street, Salem, Ohio 44460.
Institution Beyond High School
I request a transcript to be sent to the Human Resources Manager, Salem Regional Medical Center, 1995 East State Street, Salem, Ohio 44460.
I agree to assume any charges for transcripts.
Authorization for Employment Information
I grant Salem Regional Medical Center the right to obtain information concerning my past employment record. I hereby authorize my previous employers to remit information requested and absolve any employer releasing such information from liability.
Signature
The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. All applications will remain on file for a period of 2 years.
I understand that if I am hired, Salem Regional Medical Center and I both retain the right to terminate my employment with Salem Regional Medical Center at any time and for any reason. I also understand that acceptance of an offer of employment does not create an employment contract, oral or written, express or implied. I further understand that no employee or representative of Salem Regional Medical Center has the authority, at present or future, to promise me any benefit or make any contract with me, oral or written, express or implied, except the President/CEO of Salem Regional Medical Center, who can enter into contracts only in writing.
I agree that you may Obtain an investigative consumer report on me, containing information regarding my (CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS, MODE OF LIVING). I understand that an investigative consumer report involves personal interviews with sources such as my neighbors, friends, and associates. If you obtain such a report, I understand that I am entitled to a complete and accurate disclosure of the nature and scope of the investigation, provided that, within a reasonable time after I submit this application, I notify you in writing that I would like such a disclosure. I also agree that you may obtain a consumer credit report on me.
2020 - Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
Page 1 of 1
OMB Control Number 1250-0005
Expires 05/31/2023
Name:
Employee ID:
(if applicable)
Date:

Why are you being asked to complete this form?

We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.
Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
  • Autism
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS
  • Blind or low vision
  • Cancer
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or hard of hearing
  • Depression or anxiety
  • Diabetes
  • Epilepsy
  • Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome
  • Intellectual disability
  • Missing limbs or partially missing limbs
  • Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)
  • Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Please check one of the boxes below:

Yes, I Have A Disability, Or Have A History/Record Of Having A Disability
No, I Don’t Have A Disability, Or A History/Record Of Having A Disability
I Don’t Wish To Answer
 
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
 
For Employer Use Only
Employers may modify this section of the form as needed for recordkeeping purposes.

For example:
Job Title:
Date of Hire:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
Submit
Cancel
ApplicantStack powered by Swipeclock