The following instructions apply to all applications submitted for employment at Saltzer Medical Group.

Complete the application in its entirety. All items must be filled in. If you cannot remember a particular piece of information, such as a previous salary or phone number of a prior employer, please put "unknown".
Sign the application.
Do not call to ask the clinic to make additions, changes or deletions to your application. You should insure the accuracy of the application when it is submitted.
Please refrain from calling to "check" on your application or to request a job description of benefit summary. Once applications are submitted, they are sent to Human Resources.
Submitting an application is no guarantee of an interview. we receive a large number of applications and cannot guarantee everyone will receive an interview.
Once you have submitted an application and are not selected for the position applied for, your application is kept on file for 90 days from the date of submission.

Thank you for your interest in employment at Saltzer Medical Group. We wish you luck in your employment endeavors.

All employees and applicants for employment are extended equal employment opportunities without regard to race, color, citizenship, religion, national origin, age, gender, pregnancy or related conditions, disability, veteran, or current or future military status.

Saltzer Medical Group

Drug Testing Consent Form

Prospective Employees

Pursuant to my application for employment with Saltzer Medical Group, P.A., I consent to take a drug test as part of the company's drug free workplace policy.

I understand that the collection, testing, and reporting of my drug or alcohol test results will be done in accordance with the standard chain of custody procedures.

I consent to the release of my test results received from the testing laboratory by Minert & Associates, Inc. to management officials at Saltzer Medical Group and understand that those results will be held in confidence by all parties involved, subject to applicable laws.

I understand that if I test positive for the presence of illegal drugs, I will have an opportunity to discuss that result with the staff of Minert & Associates, Inc., for the purpose of providing a reasonable explanation regarding my positive drug test.

I further understand that if my test remains positive for the presence of illegal drugs, I will not be offered employment with the company.

I understand the terms of Saltzer Medical Group's drug testing policy.


Authorized Signature (Print Name)	Date
Full Time Part Time	If part-time how many hours per week?
Would you consider evening?	Yes No
Weekends?	Yes No

Employment Application

Position Desired:

Date:

Name:		Phone No.
Email:
Address:
Referred By:	When can you start:	Salary Desired:


Name and Location		Major Subjects Studied
High School:
College:
Business / Trade School:
List any job-related special skills not mentioned elsewhere on this application:

Do you speak a foreign language fluently (Only reply to this if the position applied for requires the applicant to speak a foreign language)?
Yes No	Language
Have you ever been convicted, pled no contest or received a withheld judgement for any misdemeanor or felony?
Yes No (A conviction will not automatically bar an applicant from consideration for employment).
If yes, explain:

References: List the names of three persons (not previous employers or relatives) whom you have known at least one year and whom we can contact for reference information.
Name	Address	Phone	Business	Years Known

Former Employment: List your last three enployers, starting with the most recent one first.

Employer	From	To
Address		Position
Reason for Leaving		Salary
Supervisor	May we Contact?	Phone
Duties

Employer	From	To
Address		Position
Reason for Leaving		Salary
Supervisor	May we Contact?	Phone
Duties

Employer	From	To
Address		Position
Reason for Leaving		Salary
Supervisor	May we Contact?	Phone
Duties

Upload a file with your application:

I certify all the information listed herein is correct. If a false statement or material omission is made on the application, I may be terminated from employment or disqualified from mconsideration for employment. I authorize Saltzer Medical Group to investigate the information contained herein and release Saltzer Medical Group, former employers, educational institutions and other references from all liability for releasing truthful information. I understand this application does not constitute an employment contract of any kind. Should Saltzer Medical Group employ me, I may resign such employment at any time at my discretion with or without prior notice and Saltzer Medical Group may terminate my employment at any time at their discretion with or without cause and with or without prior notice unless prohibited by law.


Authorized Signature (Print Name)	Date