6401 Patterson Pkwy
Arkansas City, KS 67005 (620) 442-2500
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General Application
General Application
The SCKMC application process consists of three forms: 1. General Application 2. Release Authorization 3. Confidentiality Agreement Please complete ALL THREE forms.
Name
*
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Last
Address
Street Address
Address Line 2
City
State / Province / Region
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Bolivia
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Christmas Island
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Congo, Republic of the
Cook Islands
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Mali
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Mongolia
Montenegro
Montserrat
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Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
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Northern Mariana Islands
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Panama
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Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Previous Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Home Phone
Cell Phone
Email
Are you at least 18 years old?
*
Yes
No
Position you are applying for:
Type of Position
Per Diem
Full Time
Part Time
Pool
PRN
Temporary
Shift
Day
Evening
Night
Weekend
Rotation
Salary Requirement
Are you willing to travel?
Yes
No
Are you willing to relocate?
Yes
No
Do you have adequate means of transportation?
Yes
No
The ability to get to work on time each day and when called in on short notice during normal working hours?
If overtime work is required periodically, does this pose a problem for you?
Yes
No
Date available for work:
Are you legally authorized to work in the U.S.?
Yes
No
Have you ever worked in this hospital?
Yes
No
If yes, please list date(s) and department(s).
Are you related to another hospital employee?
Yes
No
How did you learn about this position?
Newspaper
Employment website
Current employee
School agency
SCKMC website
Radio
Friend referral
Are you able to perform the essential job related functions of the position for which you are applying with or without reasonable accommodations?
Yes
No
Describe any accommodations necessary:
Are you currently excluded from participation in any federally funded healthcare program - including Medicare and Medicad. Or are you aware of any potential exclusion from a federally funded health program?
Yes
No
If you answer "yes" to this question you will NOT be automatically disqualified from employment consideration, except as required by State or Federal law.
If yes, explain:
Have you ever been involved in the substantiated abuse or neglect of children or adults under the laws of this or any State of the United States?
Yes
No
If you answer "yes" to this question you will NOT be automatically disqualified from employment consideration, except as required by State or Federal law.
If yes, which State and explain.
What qualities or special skills do you possess that would help you be successful?
Education History - High School
Include school name, City, State, if you graduated/GED if not last level completed (9,10,11)
Education History - College
FOR EACH SCHOOL: Include school name(s), City, State, if you graduated if not last level completed (1,2,3,4), and degree or certificate received.
Education History - Graduate School
FOR EACH SCHOOL: Include school name(s), City, State, if you graduated if not last level completed (1,2,3,4), and degree or certificate received.
Education History - Other
FOR EACH: Include school name(s), City, State, if you graduated if not last level completed (1,2,3,4), and degree or certificate received.
Work History - Current or Most Recent
Include start and end dates (month and year). Company name, phone number, address, and immediate supervisor. Job title, job status (full-time, part-time, PRN), # of hours worked per week, salary. If your name has changed, include name while employed, summarize the nature of work performed and job responsibilities, and reason for leaving.
Work History - Current
*
Yes
No
May we contact this company?
Work History - 1st Previous
Include start and end dates (month and year). Company name, phone number, address, and immediate supervisor. Job title, job status (full-time, part-time, PRN), # of hours worked per week, salary. If your name has changed, include name while employed, summarize the nature of work performed and job responsibilities, and reason for leaving.
Work History - 2nd Previous
Include start and end dates (month and year). Company name, phone number, address, and immediate supervisor. Job title, job status (full-time, part-time, PRN), # of hours worked per week, salary. If your name has changed, include name while employed, summarize the nature of work performed and job responsibilities, and reason for leaving.
Work History - 3rd Previous
Include start and end dates (month and year). Company name, phone number, address, and immediate supervisor. Job title, job status (full-time, part-time, PRN), # of hours worked per week, salary. If your name has changed, include name while employed, summarize the nature of work performed and job responsibilities, and reason for leaving.
Professional Reference - other than relatives
Provide name, company, position, address including City & State, work & home phone, and # of years known.
Professional Reference - other than relatives
Provide name, company, position, address including City & State, work & home phone, and # of years known.
Professional Reference - other than relatives
Provide name, company, position, address including City & State, work & home phone, and # of years known.
Professional License / Registration #1
Currently licensed
Eligible for license
Currently registered
Eligible for registration
Professional License / Registration #1
Include type, number, state issued, and date.
Professional License / Registration #1
Has license or registration EVER been suspended, revoked, or on probation? If YES, explain:
Professional License / Registration #2
Currently licensed
Eligible for license
Currently registered
Eligible for registration
Professional License / Registration #2
Include type, number, state issued, and date.
Professional License / Registration #2
Has license or registration EVER been suspended, revoked, or on probation? If YES, explain:
Professional Certifications #1
Currently certified
Eligible for certification
Professional Certifications #1
Include type, state issued, and date.
Professional Certifications #2
Currently certified
Eligible for certification
Professional Certifications #2
Include type, state issued, and date.
Upload Resume
Accepted file types: pdf, doc, docx, Max. file size: 10 MB.
PLEASE READ CAREFULLY
*
By clicking this box I agree to all of the preceding
By clicking this box I DO NOT agree to the preceding
South Central Kansas Medical Center is an equal opportunity employer. South Central Kansas Medical Center does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I hereby affirm that the information provided on this application is true and complete. I understand that any false or misleading reprentations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that employment may be conditioned upon successfully passing a medical examination and that I may be required to satisfactorily complete a drug screening along with a background investigation as a condition of employment. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information. I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of this facility and notarized.
For General Information, Call:
(620) 442-2500
Pricing Disclosure
OUR HEALTH NETWORK
Primary Care - Summit Clinic
Primary Care - Ark City Clinic
Primary Care - Winfield
SCK Specialty Clinic
SCK Midwives
COMMUNITY LINKS
Cowley County Health Department Website
Cowley Works / Cowley First
STATISTICS/ECONOMY
Arkansas City Profile
Arkansas City Data
Arkansas City Website
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