AHN Employment Application

Adams Health Employment Application

Below is the employment application for all Adams Health Network Divisions, including Adams Memorial Hospital, The Village of Heritage and Woodcrest of Decatur. Please select the division for which you wish to apply and continue with the application.*

Adams Health Network (includes all divisions)

Adams Memorial Hospital

Adams Heritage

Adams Woodcrest

Personal Information

State

Country

Address 2

First Name*

Phone Number*

Email Address*

City*

Last Name*

Address*

Zip Code*

Position Requested*

Salary Expected*

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*

Yes

On what date are you available to begin work? *

List any days or times you are not available to work:

Are you on lay-off and subject to recall?*

Yes

Have you filled out an application here before? *

Yes

Have you been employed by AHN or its divisions before? *

Yes

If Yes, Please Give Dates:

Reason For Leaving:

Professional Licensing

Do you hold a professional registration, license, or certificate? *

Yes

Have you ever had any professional registration, license, or certificate suspended or revoked?*

Yes

Have you ever informally resolved any recommended or potential adverse action involving your professional registration, license, or certification?*

Yes

Are any professional registration, licensure, or certification actions now pending against you? *

Yes

Has any action been taken against you that excludes or has excluded you from participation in any federal or state government healthcare program, including but not limited to Medicare? *

Yes

How did you hear about employment opportunities at AHN?

Are you a U.S. Citizen or an alien legally entitled to work in the position(s) for which you have applied? *

Yes

If you are under 18, are you eligible for a work permit?*

Yes