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Alabama Primary Healthcare Association
About Us
We Are APHCA
Approach
People
Community of Care
Get Involved
Careers
Videos
Contact APHCA
Solutions
We Deliver Results
Practice Transformation
Health Information Technology
Credentialing
Intelligent Care Program
Quality and Performance Improvement
Business Services
Learning Center
Learn. Practice. Perform.
Education & Events
Training Programs
Request Training or Assistance
Become a Sponsor
Resources
Educational and Training Assistance
Advocacy
Policy
Government Partners
Tools and Presentations
News
My APHCA
Join APHCA
Calendar
Facebook
Twitter
LinkedIn
Apply with APHCA
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General Information
Alabama Primary Health Care Association is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.
Name
*
First
Last
Date
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
Email
*
Position applying for
*
Date Available to Start
*
Are you 18 years of age or older?
*
Yes
No
Can you prove that you are a U.S. citizen or that you can legally work in the U.S.?
*
Yes
No
How were you referred to APHCA?
*
Have you ever applied or worked for APHCA before?
*
Yes
No
If yes, state when and what position:
Do you know of any friends, relatives, or acquaintances working for APHCA?
*
Yes
No
If yes, state name and the nature of relation:
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?
*
Yes
No
If no, describe the functions that cannot be performed:
Have you ever been convicted of a criminal offense (misdemeanor or felony)?
*
Yes
No
If yes, please describe the crime—state the nature of the crime (when and where convicted and disposition of the case):
Education/Training/Military
High School/GED:
Location
Did you graduate?
Yes
No
Diploma/Major
College/University:
Location
Did you graduate?
Yes
No
Diploma/Major
Other Institution:
Location
Did you graduate?
Yes
No
Diploma/Major
Languages read, written, or spoken fluently other than English:
*
Other credential/license/professional affiliations, etc., which are relevant to the job for which you are applying:
Military
Branch of Service:
Time in Service:
Highest Rank Obtained:
Specialty:
Include any military training, special honors, skills/duties, or service schools attended:
Employment History (Include voluntary/internship experience)
Recent Employer:
*
Phone
*
From (Month/Year) To (Month/Year)
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Supervisor
*
Hours per week
*
Position Title & Description
*
Last Salary
*
Reason for leaving
*
May we contact this employer?
*
Yes
No
Employer:
Phone
From (Month/Year) To (Month/Year)
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Supervisor
Hours per week
Position Title & Description
Last Salary
Reason for leaving
May we contact this employer?
Yes
No
Employer:
Phone
From (Month/Year) To (Month/Year)
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Supervisor
Hours per week
Position Title & Description
Last Salary
Reason for leaving
May we contact this employer?
Yes
No
Provide references not related to you.
*
Name/ Address/ Telephone/ Occupation
Provide references not related to you.
Name/ Address/ Telephone/ Occupation
Provide references not related to you.
Name/ Address/ Telephone/ Occupation
Resume
READ CAREFULLY: I certify that the information contained in this application for employment is true to the best of my knowledge. I understand that any misstatement or omission of information may result in denial of employment or may be sufficient cause for dismissal. I hereby authorize Alabama Primary Health Care Association to investigate the truthfulness of all statements made on this application regarding educational and employment history, misdemeanors or felonies specified, listed references, and any other persons who can verify information.
Authorization Signature of Applicant
Date
Phone
Submit