Join Stedman-Wade Health Services Inc.

Personal Information

SWHS complies with the Federal COVID-19 Vaccine Mandate as established by the "Medicare and Medicaid Program; Omnibus COVID-19 Health Care Staff Vaccination." All SWHS employees, board members and volunteers must be fully vaccinated prior to starting employment. Can you provide proof of COVID-19 vaccination? *
Referral Source
Are you legally authorized to work in the United States? *
Have you submitted an application here before? *
Have you ever been employed here before? *
Type of employment desired: *
Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)? *
Have you ever pleaded "guilty" or "no contest" to or been convicted of a crime? *


Days Available (if applying for a part-time position)

Employment History

Employer 1
May we contact? *
Employer 2
May we contact?
Employer 3
May we contact?
If not addressed on previous page, have you ever been fired or asked to resign from a job? *


Reference 1
Reference 2
Reference 3


Starting with your most recent school attended, provide the following information.
Completed *

Skills & Qualifications

Do you have a current CPR or BLS card? *

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