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Operating Hours
7:00 a.m. to 5:00 p.m.

NowCare Hours
M-F: 8:30 a.m. to 5:30 p.m.
Weekends: 9:00 a.m. to 3:00 p.m.

Pharmacy Hours
M-F: 8:30 a.m. to 5:00 p.m.

Lab Hours
M-F: 7:00 a.m. to 5:30 p.m.
Sat: 8:00 a.m. to 1:00 p.m.

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Employment Application

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Thank you for your interest in employment at HIMG. We are always accepting applications and encourage you to check back often for new and exciting opportunities.

First Name:
Last Name:
Middle Initial:
Address:
City:
State:
Zip Code:
Phone Number:
Best Time to Reach you at Home:
Email Address:
Over 18: Yes No
Position applied for:
Referral Source (Please check the appropriate category)
Name the source:
Do you have any relatives working at HIMG?
May we contact you at Work: Yes No
Have you submitted an application here before: Yes No
Have you ever been employed here before: Yes No
Are you legally eligible for employment in this country: Yes No
Date Available for work:
What is your desired salary range or hourly rate of pay?
 
$:
Per:
Type of employment desired: (to choose more than one press Ctrl and click)
 

Employment History

Employer:
Telephone:
Address:
City:
State:
Zip Code:
Starting Job Title:
Immediate Supervisor Name:
Immediate Supervisor Title:
May we contact for reference?
Reason for leaving?
Summarize the type of work performed:
Job Responsibilities:
What did you like most about your position?
What were the things you liked least about your job?
Dates Employed: -
Starting Compensation
 
$:
Per:
Commission/Bonus/Other Compensation
Final Compensation
 
$:
Per:
Commission/Bonus/Other Compensation
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
If not addressed on previous page, have you ever been fired or asked to resign from a job? Yes No


Skills and Qualifications

  
Summarize any special training skills, licenses and/or certificates that may assist you in performing the position for which you are applying
Computer Skills (Check appropriate boxes. Include Software titles and years of experience)

Word Processing

 Years:

Spreadsheet

 Years:

Presentation

 Years:

E-mail

 Years:

Internet

 Years:

Other

 Years:

Other

 Years:

Other

 Years:

Educational Background

Starting with your most recent school attended, provide the following information
School Name:
Dates Attended: From:
  To:
Education Achieved:
Diploma
GED
Degree
Certification
Other

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Reference 1

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Relationship:
Phone:
Company:

Reference 2

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Relationship:
Phone:
Company:

Reference 3

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Relationship:
Phone:
Company:
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Applicant's Certification:

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. I also agree that falsified or omitted information may disqualify me from further consideration from employment and may be considered justification for dismissal if discovered at a later date.

I understand that if I am employed by HIMG my employment can be terminated, with or without cause, at any time at the discretion of either HIMG or by me. I understand that no management official, except as authorized in writing by the Board of Directors of HIMG has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment. Any contractual agreement authorized by the Board of Directors will be in writing and duly signed.

I authorize persons, schools, my current employer, if applicable, previous employers, organizations, and references named in this application to provide any relevant information that may be required to arrive at any employment decision, and I expressly authorize HIMG to contact any of these for such purposes. I also expressly release those above authorized from any and all employment liability and will supply additional authorizations and releases as may be deemed necessary to assist in arriving at any employment decision.

I further agree that if I am employed by HIMG that I will abide and comply with all of HIMG's rules and regulations, unless otherwise specifically agreed to in writing. I also understand and agree that any employment rules, regulations, handbooks, guidelines, manuals, or policies that may be distributed or given to me during such employment with HIMG shall be subject to change at the discretion of HIMG and shall not be construed as a contract.

I understand that continued employment is contingent upon providing proof of employment eligibility under immigration laws and regulations.

I Agree to the above certification