Online Application

Applicant Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Home Phone #
Mobile Phone #
Are you at least 18 years of age and legally eligible to work in the U.S.?*
- Yes
- No
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?*
- Yes
- No
Employment Desired
Date you can start work*
MM slash DD slash YYYY
Hourly Rate/Salary Desired
Position Desired*
Please select all available openings for which you wish to apply
- Mental Health/Substance Abuse Health Educator
- Executive Administrative Assistant
- Dental Support Staff- Morgan County
Do you understand the job requirements?*
- Yes
- No
If no, please explain?*
Are you currently employed?*
- Yes
- No
If so, may we inquire of your present employer?*
- Yes
- No
Referral Source
How did you hear about us?*
- Website
- Social Media
- Job Site
- Newspaper
- Friend
Have you ever worked for this company before?*
- Yes
- No
Do you know anyone who works for our company?*
- Yes
- No
If yes, who?
Are you a close relative of a member of the Juniper Health Board of Directors?*
A close relative is defined as spouse, children, step-children, mother, father, siblings, grandparents, in-laws of the same or any other member of the board member’s household. For a list of our Board members, CLICK HERE
- Yes
- No
Have you ever filed an application with us before?*
- Yes
- No
Education
Name of High School
High School Address
Street Address City State ZIP Code
Number of Yrs. Attended
Did you graduate?
- Yes
- No
Degree
Subjects Studied/Major
Name of College
College Address
Street Address Address Line 2 City State ZIP Code
Number of Years Attended
Did you graduate?
- Yes
- No
Degree
Subjects Studied/Major
Other School: Name
Other School: Address
Street Address City State ZIP Code
Number of Years Attended
Did you graduate?
- Yes
- No
Degree
Subjects Studied/Major
Employment History
Please start with your present or most recent employment. If you need to list additional employment, please do so on a resume and attach to the application.
Job Title
Company Name
From Date:
MM slash DD slash YYYY
To Date:
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Phone
Responsibilities:
Supervisor:
First Last
Supervisor Title
Reason for Leaving
Job Title
Company Name
From Date:
MM slash DD slash YYYY
To Date:
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Phone
Responsibilities:
Supervisor:
First Last
Supervisor Title
Reason for Leaving
Job Title
Company Name
From Date:
MM slash DD slash YYYY
To Date:
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Phone
Responsibilities:
Supervisor:
First Last
Supervisor Title
Reason for Leaving
Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.
References
Give the names of three persons not related to you, whom you have known at least three (3) years and could attest to your work ethic. Juniper Health employees cannot serve as personal references.
Full Name*
First Last
Reference #1
Address
Street Address City State ZIP Code
Phone*
Email
Company
Years Acquainted
Full Name*
First Last
Reference #2
Address
Street Address City State ZIP Code
Phone
Email
Company
Years Acquainted
Full Name*
First Last
Reference #3
Address
Street Address City State ZIP Code
Phone
Email
Company
Years Acquainted
Your Resume & Cover Letter
Cover Letter - Upload Here
Max. file size: 300 MB.
Resume - Upload Here
Max. file size: 2 MB.
Please upload a PDF version of your resume here
DISCLAIMER AND SIGNATURE
PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Juniper Health, Inc to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of Juniper Health, Inc serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, and to comply with company and departmental regulations.

Juniper Health, Inc. is an equal opportunity employer and 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.
E-Signature*
Name
Today's Date*
MM slash DD slash YYYY
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Online Application

Applicant Information

Employment Desired

Referral Source

Education

Employment History

References

Your Resume & Cover Letter

DISCLAIMER AND SIGNATURE

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