Online Application

Position Desired
First Name
Last Name
Email
Primary Phone Number
Secondary Phone Number
Address
Apartment #
City
State	Select a State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip
Current (or most recent) Employer
Current (or most recent) Job Title
Current (or most recent) Compensation
May we contact your current employers?	Yes No
Please list any employer(s) you do not wish us to contact
Have you have plead guilty or been convicted of a felony or misdemeanor? A criminal conviction will not be necessarily a barrier to employment.	Yes No
Please list the dates and offenses
Have you ever been employed by Kane Community Hospital or Hamot Medical Center before?	Yes No
If yes, please list the dates employed, departments and previous names
If you have any first line relatives, or a spouse that works for KCH please list the name(s) and department(s) that they work in
Are you at least 18 years of age?	Yes No
Education Completed
Licenses or Certifications
If you have a license, please list the State, Registration number and Expiration date
Salary Expectation Type	Annually Hourly Open
Salary Minimum
Shift Preference	First Second Third Any

You may also send a Cover Letter and Resume to

Marsha Keller, MBA, PHR
Senior Manager, Human Resources
Kane Community Hospital
4372 Route 6
Kane, PA 16735
mkeller@kanehospital.org

Several positions at the hospital require the fingerprint based FBI clearance www.pa.cogentid.com (select the Department of Public Welfare link) and the Act 33 Pennsylvania Child Abuse Clearance Pennsylvania Child Abuse History Clearance Form (CY-113).