Board Member Application

Employment Application

Employment Openings

Please see current job openings and fill out the online employment application or dowload pdf version. You have the option of uploading your resume or sending it with the paper application.

A representative from our Human Resources Department will contact you.

If you have questions, comments, or are having an issue accessing our employment application, please send us your feedback so that we may improve our services.

Employment Benefits

Health Insurance
Dental

Life Insurance

Vacation

401K Plan

Paid Holidays

EMPLOYMENT APPLICATION

Broward Community and Family Health Centers, Inc. (BCFHC), is an Equal Opportunity Employer. Personnel are selected on the basis of qualifications and ability, without regard to race, color, religion, sex, age, national origin, marital status, sexual orientation, disability, or veteran status, and in compliance with federal, state, and local laws.

Personal Information

Name*

Age:

DOB:

Address*

Zip*

City*

Contact Information

Home Phone*

Cellular Phone*

Email Address*

Employment Desired

Select Position(s)* ARNP Certified Nurse Midwife Chief Medical Officer Clinical Social Worker Dental Assistant General Dentist Dental Hygieniest Environment Specialist Family Medicine Physician Hospice Chaplain Lab Technician LPN Maintenance Worker Medical Assistant Medical Scribe Nurse Manager Nurse Practitioner Patient Services Representative Pediatrician Pharmacist Pool-Dental Assistant Referral Specialist Staff Staff Accountant

Employment Start Date*

Job Type*

Salary Requirements:*

Center(s) Applying For* CENTRAL BROWARD CENTER HOLLYWOOD CENTER POMPANO CENTER POMPANO DENTAL CENTER WEST PARK CENTER

I understand that conditions may require me to work shifts and locations other than the one for which I am initially assigned and I agree to such scheduling change(s) as directed by BCFHC.

Applicant’s Name*

Date:*

General Employment Information

Are you at least 18 years of age?

If hired, can you present proof of your identity and legal right to work in the United States?

Have you worked for BCFHC before (either on our payroll, through an agency, or as a consultant/contractor?)

Are any friends or relatives (including parents, siblings, spouse, and domestic partner) employed by BCFHC? If yes, give name(s) and position(s) of friends and/or family members.

Name(s) and Position(s)

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? If yes, state nature of the crime(s), when and where convicted, and disposition of case(s). Note: Answering yes to this question does not constitute an automatic bar to employment. Only those crimes substantially related to the position you are seeking will be considered.

Nature of the crime(s), when and where convicted, and disposition of case(s).

Have you received and read a copy of the job description for (each of) the position(s) for which you are applying? (If yes, please answer the following question. If no, please continue to next section.)

Are you able to perform the specific tasks described in the job description, with or without accommodation?

Employment Record

Present and Former Employers

Name

Address

Supervisor’s Name

Phone

May we contact?

Dates Employed

From:

To:

Salary Range

Starting:

Ending:

Job Title and Description

Title

Duties

Average # of Hours/Week

Reason for Leaving

Employment Record #2

Present and Former Employers

Name

Address

Supervisor’s Name

Phone

May we contact?

Dates Employed

From:

To:

Salary Range

Starting:

Ending:

Job Title and Description

Title

Duties

Average # of Hours/Week

Reason for Leaving

Employment Record #3

Present and Former Employers

Name

Address

Supervisor’s Name

Phone

May we contact?

Dates Employed

From:

To:

Salary Range

Starting:

Ending:

Job Title and Description

Title

Duties

Average # of Hours/Week

Reason for Leaving

Employment Record #4

Present and Former Employers

Name

Address

Supervisor’s Name

Phone

May we contact?

Dates Employed

From:

To:

Salary Range

Starting:

Ending:

Job Title and Description

Title

Duties

Average # of Hours/Week

Reason for Leaving

Please explain all periods of unemployment:

Age:

Education, Training, and Experience

How many years of High School did you complete?

Do you have a diploma or something equivalent?

How many years of College did you complete?(Undergraduate or Postgraduate?)

Any Degrees?(Undergraduate,Graduate,Doctoral)

School Name and Location

Type of School

Academic Major Subject(s)

Diploma, Degree or Certificate Received

Scholastic Honors Received

Typing WPM

Medical Terminology

Word Processing

If yes, list programs:

Many of our patients do not speak English. Do you speak, write, or understand any foreign languages?

American Sign Language

Military Service

Were you in the U.S. Armed Forces?

Were you separated from service for any reason other than honorable discharge?

Have you obtained any special skills or abilities as a result of service in the military?

If yes, describe:

References

List below three persons with whom you have worked, preferable within the last three years.

Name:*

Position/Occupation*

Company/Organization*

Address*

Telephone No.(Work)*

Telephone No.(Home)*

Years Acquainted

Work Relationship:* Supervisor Co-Worker Staff Other

Name:*

Position/Occupation*

Company/Organization*

Address*

Telephone No.(Work)*

Telephone No.(Home)*

Years Acquainted*

Work Relationship:* Supervisor Co-Worker Staff Other

Name:*

Position/Occupation*

Company/Organization*

Address*

Telephone No.(Work)*

Telephone No.(Home)*

Years Acquainted*

Work Relationship:* Supervisor Co-Worker Staff Other

If your former employment references, education, or military service are under a name other than indicated on the from of this application, please indicate here:

APPLICANT CERTIFICATION

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that all the information provided in this application is true and correct to the best of my knowledge. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize BCFHC to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons, companies or corporations supplying such information. I agree that, if hired, I will follow all BCFHC policies, rules, procedures, and all other directions. I understand that BCFHC reserves the right to add to, change, and/or delete its policies, procedures, work rules, and benefits at any time, without prior notice and that no one in BCFHC has the authority to enter into any agreement, for any particular period of time, or contrary to the above terms, unless that agreement is set forth in writing and signed by the CEO of BCFHC. I understand that, if I am hired, unless otherwise stated, my employment is at-will, and that either party is free to terminate the employment relationship at any time for any reason, and that BCFHC may make other decisions, such as transfers, demotions, promotions, and disciplinary action, with or without cause and with or without notice.

Applicant Name

Date