Employment Application

Thank you for your interest in Pacific Northwest University of Health Sciences
At Pacific Northwest University of Health Sciences (PNWU), we strive for a culture that supports our mission and values. We invest the time and resources to ensure we hire the right candidates who fit our culture and dedicate their work-life to enriching the people and educational programs at PNWU.

Mission

Pacific Northwest University of Health Sciences educates and trains health care professionals emphasizing service among rural and medically underserved communities throughout the Northwest.

Vision

Continually improving the availability and quality of health care for those we serve.

Institutional Values

Mission Driven - Committed to create, sustain, and improve quality educational programs specifically for rural and medically underserved communities

Collaborative - Working together with thoughtful actions, efforts, and concerns to meet each opportunity, issue, or challenge presented

Compassionate - Every individual is respected and treated with consideration, kindness, and understanding

Genuine - Real people providing real solutions which have direct impact on community health, resources, and outcomes

Student Focused - Unwavering support for every student empowers all to realize their full potential

Healthy - At PNWU, you'll learn what it means to be part of a healthy community, and how you thrive by being part of it

Core Themes
Academic Success
Health Care Professionals for the Rural and Medically Underserved of the Northwest
Service to Community

PNWU is a drug-free workplace and equal opportunity employer.

If you feel you are the right candidate for one of our posted positions, please complete the application for employment and hit "submit" below to send it electronically or print the application and fax/scan or mail it to:.

Pacific Northwest University of Health Sciences

Attn: Human Resources

111 University Parkway, Ste. 202

Yakima, WA 98901

HR@pnwu.edu

P: 509-452-5100

F: 509-452-5101
PERSONAL DATA
Application Date*

MonthDayYear
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
YesNo
Position for which you are applying:
Salary Requirement:
What days/hours are you available for work?
How did you hear about this job?
Have you ever been employed by Pacific Northwest University?
Are you legally able to be employed to work in the U.S.?
When are you available to begin work?

MonthDayYear
Are you able to perform the essential functions of this position with/without accommodations?
Have you been convicted of a crime and/or released from confinement following a conviction related to theft, fraud, violence, and/or drug manufacture or distribution? If yes, please give date, place and nature of each such conviction on a separate piece of paper and attach it to the application. Such conviction(s) may be relevant if job related, but is not an automatic bar from employment. Arrest or charges that have been expunged do not need to be disclosed.
Have you had any findings made against you in any civil adjudicative proceeding?
Have you ever been suspected or directly or indirectly associated with terrorist activity as defined by the USA PATRIOT Act?
Have you ever had an adverse action taken, or one pending, on your professional license to practice?
Have you ever had, or one pending, a professional malpractice claim made against you?
EDUCATION
High School Name/Location
Number of Years Attended
Graduated?
Degree or Field of Study
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College/University
Number of Years Attended
Graduated?
Degree or Field of Study
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Tech/Voc School
Number of Years Attended
Graduated?
Degree or Field of Study
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Graduate School
Number of Years Attended
Graduated?
Degree or Field of Study
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Other
Number of Years Attended
Graduated?
Degree or Field of Study
--------------------------------------------------
Professional Licenses/Certifications
Number of Years Attended
Graduated?
Degree or Field of Study
--------------------------------------------------
Second Language
Number of Years Attended
Graduated?
Degree or Field of Study
REFERENCES
Name
Address
Phone Number

Area CodePhone Number
Association
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Name
Address
Phone Number

Area CodePhone Number
Association
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Name
Address
Phone Number

Area CodePhone Number
Association
EMPLOYMENT HISTORY

List 10 years of employment history
Company#1:
Company Name
Supervisor's Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Duties
Dates of Employment
Salary
Reason for Leaving
Company #2:
Company Name
Supervisor's Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Duties
Dates of Employment
Salary
Reason for Leaving
Company #3:
Company Name
Supervisor's Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Duties
Dates of Employment
Salary
Reason for Leaving
Under penalty of perjury, I certify that the above information is true, correct and complete. I understand that if I am hired, I can be discharged for any misrepresentation or omission in the above application. I also understand that if I am hired, my employment is conditioned on your receipt of a satisfactory report from the Washington State Patrol. I understand that I will not be approved for employment if I have ever been a suspected terrorist or associated directly or indirectly with terrorist activities, as defined by teh USA PATRIOT Act.
Signature:*
My typed signature is my symbol and intent of authentication where I willingly signed, understand, and adopt this document.
Date*

MonthDayYear
We may request your fingerprints to complete the Washington State Patrol report for record or criminal convictions for offenses against persons, civil adjudications, and disciplinary board of final decisions. We will make you a copy of the report upon your request.
PRE-EMPLOYMENT CONSENT AGREEMENT

I certify that the information set forth in the Application for Employment is true and complete to the best of my knowledge. I understand that misrepresentation or omission of the facts requested may result in disqualification of my application or dismissal if I have been employed.
I consent to and authorize disclosure of any of the following documents or information in the course of consideration for employment:
• Successfully passing a post offer drug screen
• Employment verification and reference checks
• Verification of eligibility for employment in the United States in accordance with the Immigration Reform and Control Act of 1986, post offer
• Washington State Patrol Criminal Background check, post offer
• Nationwide Wants & Warrants, post offer
• Federal Criminal and County Civil Background check, post offer
• Sex Offender Background check, post offer
• Social Security Trace, post offer
• Verification of Education
• Verification of licensure and certifications
I hereby release all parties and persons connected with any request for information from all claims, liabilities and damages for any reason arising out of furnishing of such information.
I understand that this Application for Employment is not a contract for employment. I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of University policies. If I am employed by this University, I agree to confirm to the standards of conduct and performance and the personnel policies of the organization, which standards and policies may be unilaterally amended by this University from time to time.
I understand and agree that if I am offered employment by this University, my employment will be for no definite term and that either I, or the University will have the right to terminate the employment relationship at any time, with or without cause, and with or without notice. I also understand that this status can only be altered by the President/Vice President of the University.
If employed, I further agree that if during the course of my employment the University advances any paid leave to me before it has been earned or accrued, overpays me, or advances or loans me any money for goods and services for which I have not paid for, or if through my dishonest or willful act, lose, damage or fail to return any University property, my signature on this application is my authorization to the University to deduct from my wages or any other amounts the University may owe me, sufficient funds to repay what I owe the University or to replace the University's property.
This release shall remain in effect for the length of my employment and pertain to future release of the above information for employment related purposes.
Applicant Signature:*
I have read and understand the consent agreement and conditions of employment.
PNWU is an equal opportunity employer and makes employment and student application decisions on the basis of merit. PNWU strives to have the best available student and individual in every position. The University shall not discriminate against faculty, staff, volunteers, students, or applicants on the basis of race, ethnicity, color, religion, sex, gender, national origin, age, disability, sexual orientation or gender identity, marital status, or any other characteristic protected by law for any reason including recruitment, selection and promotion.
Self Identification Form

This University is an Equal Opportunity Employer and the information requested here is not included as part of the application process. Providing this information is voluntary and confidential. A decision not to provide this information will not result in any adverse treatment of your employment application. It is an unlawful employment practice for an employer to fail or refuse to hire, promote or discharge any individual, or otherwise to discriminate against an individual with respect to that individual's terms and conditions of employment, based on individual's race, sex, marital status, color, religion, national origin, sexual orientation, physical/mental disability or condition, or age (except for those less that 13) as defined by state and federal laws and regulations, except when bona fide occupational qualifications exists that restricts or excludes applicants based ont hat bona fide occupational qualification.
Position Desired:
MaleFemale
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 AfricaBlack or African American (Not Hispanic or Latino): a person having origins in any of the black racial groups of AfricaNative Hawaiian or Other Pacific Islander (Not Hispanic or Latino): a person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific IslandsAsian (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 Phillippine Islands, Thailand, and VietnamAmerican Indian or Alaska Native (Not Hispanic or Latino): al person having origins in any of the original peoples of North and South America (including Central America) who maintains tribal affiliation or community attachmentTwo or More Races (Not Hispanic or Latino): alll persons who identify with more than one of the above five racesI do not wish to complete this self-identification
Signature:
My typed signature is my symbol and intent of authentication where I willingly signed, understand, and adopt this document.
Date:

MonthDayYear
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Thank you for your interest in Pacific Northwest University of Health Sciences

PERSONAL DATA

EDUCATION

REFERENCES

EMPLOYMENT HISTORY

PRE-EMPLOYMENT CONSENT AGREEMENT

Self Identification Form