UAB Highlands
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UAB Highlands Online Employment Application

Search
Choose the UAB facility to which you are applying
Choose an area of interest
Choose a position

I would like to apply for the following posted position(s):
1.
2.
3.
4.

Please specify at least one position above in order for your application to be considered.

Hours you are able to work:
(check all that apply)
1st Shift 2nd Shift 3rd Shift

I am interested in working:
Full Time
Part Time


Last Name:
First Name:
Mid. Name:
Address:

City:
State:
Zip Code:
Years spent at current address:
(Enter 1 if less than 1 year)
Phone:
Cell / Beeper:
E-mail:
Drivers License #:
(optional)

May we contact you at work?
Yes
No

Are you 19 years of age or older?
Yes
No

Have you previously submitted an application for employment?
Yes
No

Are you legally eligible for employment in this country?
Yes
No

Will you work overtime if required?
Yes
No

Are you able to meet the attendance requirements of the job?
Yes
No

Have you been convicted of a felony in the last 7 years?
(Conviction will not necessarily be a bar to employment.)
Yes
No

Have you ever been convicted of a criminal offense related to healthcare?
Yes
No

Have you ever been associated with UAB in any employment capacity?
Yes
No

If Yes, please list when and department:

Are you a relative of anyone working for UAB?
Yes
No

If Yes, please list name, relationship and department:

Do you have the ability to perform the essential job functions, with or without accommodations, for the position(s) for which you have applied?
Yes
No

If No, please describe:

How did you hear about career opportunities at UAB Hospital?


Educational Background
List high school, college, university or technical schools attended, starting with the most recent. List number of years completed, degree or diploma earned, if any, and major field of study.

School 1:
City/State:
Yrs. Attended:
Course of study:
Did you graduate/complete?
Yes
No

School 2:
City/State:
Yrs. Attended:
Course of study:
Did you graduate/complete?
Yes
No

School 3:
City/State:
Yrs. Attended:
Course of study:
Did you graduate/complete?
Yes
No

School 4:
City/State:
Yrs. Attended:
Course of study:
Did you graduate/complete?
Yes
No

New Graduates: Please enter your graduation date.


Current Certifications / Licensure
Please include any current certifications or licensure along with the state and expiration date.

(Maximum characters: 512 Available Characters Left: )


Employment History
Please provide the following information for your past and present employers, assignment or volunteer activities, starting with the most recent.

Employer 1:
Address:
Phone:
Job Title:
Immediate Supervisor & Title:
Reason for leaving:

Dates employed:
From To

Hourly rate:
Starting Final

May we contact above supervisor/employer for a reference?
Yes
No
Later


Employer 2:
Address:
Phone:
Job Title:
Immediate Supervisor & Title:
Reason for leaving:

Dates employed:
From To

Hourly rate:
Starting Final

May we contact above supervisor/employer for a reference?
Yes
No
Later


Employer 3:
Address:
Phone:
Job Title:
Immediate Supervisor & Title:
Reason for leaving:

Dates employed:
From To

Hourly rate:
Starting Final

May we contact above supervisor/employer for a reference?
Yes
No
Later


Employer 4:
Address:
Phone:
Job Title:
Immediate Supervisor & Title:
Reason for leaving:

Dates employed:
From To

Hourly rate:
Starting Final

May we contact above supervisor/employer for a reference?
Yes
No
Later


Have you ever worked as a travel nurse, and if so, for what company?
Comments:
(Maximum characters: 512 Available Characters Left: )




UAB Health System Statement of Policy
The UAB Health System (UABHS) is an Equal Opportunity Employer. As such, UABHS pledges to take the necessary action to preclude discrimination in recruiting, employment, training, disciplining and/or terminating of employees because of race, color, creed, age, sex, national origin, disability, veteran status or other reason in accordance with all applicable state and federal statutes and regulations which prohibit discriminatory personnel practices.

Certification By Applicant
I certify that the information given on this application and in all other supporting documentation, resume, etc. is true and correct. I understand that any false information, willful or negligent misrepresentation, or failure to disclose any requested information will constitute sufficient grounds for UABHS to terminate my employment without notice. I further understand that UABHS will perform a pre-employment investigation to determine my suitability for employment and I authorize UABHS to secure the information necessary to make a decision. I hereby release from liability any and all individuals and organizations who provide information to UABHS concerning my professional competence, ethics, character and other qualifications and authorize my prior employers to release any requested information from my personnel files. I further understand that UABHS will adhere to applicable state and federal statutes concerning the securing of information, handling, utilization and release of information obtained in the pre-employment investigation. I acknowledge by my signature that I have read and understand these statements.

By checking this box, I acknowledge that I have read and understand these statements.




If you wish to clear the form and start again,
click the Reset Form button.

If you are finished and ready to forward your application to UAB Hospital Human Resource Management,
click the Submit Form button.

  

UAB Highlands
UAB Highlands

UAB Highlands

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