Auxiliary (Volunteer) Application

Auxiliary (Volunteer) Application












































  • Name and Location Diploma Obtained Year Obtained  
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  • Name and Location Degree Obtained Year Obtained  
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  • Name and Location Certification Obtained Year Obtained  
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  • Name Phone Number Connection  
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  • Certification and Disclaimer

    I certify that my answers are true and complete to the best of my knowledge. If this application leads to selection, I understand that false or misleading information in my application or interview may result in my release.
  • By placing my signature, I agree to the authorization terms as listed above.
  • I understand that, as a condition of my consideration for employment with The Physicians Hospital in Anadarko (“TPHA”), or as a condition of my continued employment with TPHA, TPHA may obtain a consumer report that includes, but is not limited to, my creditworthiness or similar characteristics, employment and education verifications, social security verification, criminal and civil history, personal interviews, DMV records, any other public records and any other information bearing on my credit standing, credit capacity, character, general reputation, personal characteristics and trustworthiness. I hereby authorize and consent to TPHA’s procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, TPHA will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with TPHA. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report. The following is my complete and legal name, and all information is true and correct to the best of my knowledge. By signing below I consent to the procurement of a consumer report in connection with my application for employment.