Please Provide Information About Yourself

Please answer the following preliminary questions:
To help us better know you and further assess your qualifications for this position, please answer the following questions as accurately as possible.

Education Please list the educational experiences below, starting with the highest level completed. Add entries for all relevant education completed or in progress. You must specify 1 education entry.

Location

Certifications and Licensure
Start by entering the most relevant certification/licensure and continue until you have entered all that you feel are important to disclose for this job. Do not list expired certifications/licensures.

List your work experiences below:
Starting with the most recent. Please specify at least 2 work experience entries. Enter N/A when not applicable.

Three work references are required (Note: At least two of these referees should have been your immediate supervisor in your past or existing role)

Please provide the information requested in the fields below regarding diversity.

Alpha Healthcare Institute provides equal employment opportunity for all applicants and employees.

Alpha Healthcare Institute will not discriminate or tolerate discrimination against employees or applicants based upon race, color, religion, gender, national origin, sexual orientation, gender identity, age, military duty, citizenship, marital status, disability, veteran’s status or any other basis protected by federal, state or local law. Drug Free Workplace.

Important - Applicants Please Read
Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, marital status, ancestry, physical or mental disability, veteran status or sexual orientation. As a federal contractor, we are required to maintain records of the race and gender of all applications for our Affirmative Action Plans. The information requested is confidential and will be used solely for statistical purposes. Choosing to complete this form will not affect your consideration for employment.
Please Note - Completion of this page is required
If you do not wish to supply this information, simply select "I do not wish to provide this information" for each of the questions below. Refusal to provide specific ethnicity, gender, or race information will NOT subject any applicant or employee to adverse treatment. The information that you provide will be recorded and maintained in a confidential file, separate from all other records. This information will not be used in consideration for your employment.
Race/Ethnicity Descriptions
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino) - All persons having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) - A person who identifies with more than one race (i.e. White, Black/African American, Native Hawaiian/Other Pacific Islander, Asian, or American Indian/Alaska Native).

Voluntary Self-Identification of Disability (OMB control number 1250-0005)
Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.

To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability.

Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years.

You may voluntarily self-identify as having a disability on this form without fear of punishment because you did not identify as having a disability earlier.

Please read the following statement carefully, then acknowledge that you have read and approved it by providing the information requested at the bottom of the page. Please note that an esignature is the electronic equivalent of a hand-written signature.

You are providing to Alpha Healthcare Institute some of your personal information. Alpha Healthcare Institute has taken the necessary steps to meet data privacy requirements. By completing this online form, you are authorizing Alpha Healthcare Institute to review your data where it will be kept in confidence for a minimum of 3 years. The information collected in our recruitment system will be accessible to selected Alpha Healthcare Institute employees who carry out duties relevant to the recruitment process and administration of the site.

• Assess your qualifications and personal experience to determine if they meet specific job requirements.
• Help us inform candidates of future job openings at Alpha Healthcare Institute.

If at any point you decide not to complete the application, exit and do not sign and submit. The application will not be processed until it is complete and submitted by you in accordance with the procedures of this site.

Please read the following statement carefully and then acknowledge that you have read and approved it by providing the information requested at the bottom of the page. Please note that an eSignature is the electronic equivalent of a hand-written signature.

I certify that all the information I have provided on this application and on any accompanying documents is true and correct. I understand that any false statements I have made herein or my failure to disclose requested information may disqualify me from consideration for employment, or, if employed, may result in my termination.

I hereby authorize Alpha Healthcare Institute, its agents and employees to contact any reference provided by me during the application process, and I authorize all references so contacted to release any information about me that they may have.

I further authorize Alpha Healthcare Institute or its agents to perform any investigation or background check of local, state and federal records relating to any criminal conviction I may have.

I release Alpha Healthcare Institute, its agents, officers and employees, and any reference contacted by Alpha Healthcare Institute from any and all liability that may result from any investigation or reference check.

I understand and acknowledge that I may be required to undergo a post-offer, pre-placement physical exam, and a post-offer, pre-placement drug screening analysis for substance abuse. I understand that the result may, to the extent permitted by law, result in the revocation of any offer of employment.

I understand and acknowledge that Alpha Healthcare Institute will screen my application with the Office of Inspector General ("OIG") and/or the General Services Administration ("GSA") to certify that I am not on the list of individuals excluded from participating in federal programs, including Medicare and Medicaid. Alpha Healthcare Institute will not consider me for employment if I am on the "Exclusion List".

I understand and acknowledge that nothing in this application or in any interview which I may be granted is intended to create a contract of employment between Alpha Healthcare Institute and me. I further understand and acknowledge that, if I am offered employment, I am free to terminate my employment at any time, for any reason, and the company retains the same right.

I further understand that by completing the application process and entering the requested information below, I am certifying that I am the person identified on the application and whose name is typed below.

Do Not E-Sign Until You Have Read The Above Statement.

By my eSignature, I certify that all the information I have provided on this application is true and correct to the best of my knowledge and belief. I understand that any false statements I have made herein may disqualify me from consideration for employment. I also understand that, if I am employed, I will be liable to termination or dismissal if any of the statements in my application are found to be deliberately misleading or false. Please signify your acceptance by entering the information requested in the fields below.