(Please check the appropriate category and list the source.)

Please list positions starting with the most recent. If you need more space you may attach additional sheets. A resume may be attached but will not be substituted for completion of this section.

Please list three persons not related to you who have knowledge of your work performance within the last three years.

La Maestra Community Health Centers has the following set of behaviors, which define what behaviors employees are required to practice while representing LMCHC. Please review these standards to enhance our culture of commitment to service excellence. By signing this application, you are indicating that you acknowledge and understand these behavior expectations.

Attitude At La Maestra Community Health Centers, we believe that we are here to serve our customers. Our customers include patients and their family/visitors, co-workers, volunteers, and physicians. Our customers most basic expectation is to be treated with courtesy. We are committed to providing the highest quality of service and meeting our customers needs with utmost care and courtesy. This commitment must be reflected in our behavior.

Appearance Our appearance represents the La Maestra Community Health Centers organization. Therefore, our grooming and dress will reflect respect for our customers. While on duty, we will first consider our customer s expectations in how we present ourselves. Our manner and expression will convey our concern for and willingness to serve our customers. We will take pride in our facility and do our part to maintain an uncluttered and litter-free work place.

Communication The goal of communication is understanding. We must be committed to listening attentively to our customers in order to fully understand their needs. Close attention will be given to both verbal and nonverbal messages. Our messages to customers should be delivered with courtesy, clarity, and care. We must avoid confusing customers and speak in terms they can easily understand. This applies to our greetings and introductions, telephone etiquette, giving directions, customer information & education, and confidentiality.

Response to Customers We will respond to all of our customers in a way that demonstrates the care, courtesy, and respect our customers deserve. This applies to our response to call lights, and other customers that may have to wait for our services.

Commitment to Co-Workers As La Maestra Community Health Centers employees, we are linked to one another by a common purpose: serving our patients and our community. Our co-workers, therefore, are our teammates. They deserve our respect. Without their contributions, none of us can do our jobs. Just as we rely on our fellow employees, they rely upon us. Each of us has obligations to our coworkers.

Elevator Etiquette Elevator etiquette can create a favorable impression for our patients, visitors, and co-workers. Good elevator manners contribute to patient satisfaction and smooth transportation.

Privacy We will ensure our customers right to privacy and modesty by creating and maintaining a secure and trusting environment. When entrusted with a customer s affairs, we will treat all information as confidential. Discussion of these matters will be restricted to situations where the information is necessary to meet the customer s health needs. Our concern for customers privacy will help promote peace of mind and lessen their anxiety.

Safety Safety must be the responsibility of all La Maestra Community Health Centers employees to ensure an accident-free environment. That is a fundamental part of your job performance. Accidents are the result of actions and attitudes that you can help eliminate.

Sense of Ownership Every La Maestra Community Health Centers employee must feel a sense of ownership toward his or her job. By this we mean taking pride in what we do, feeling responsible for the outcomes of our efforts, and recognizing our work as a reflection of ourselves.

 

I certify that all information I have stated in this application is true, complete and correct to the best of my knowledge, and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.

I understand this application will be active for a period of 30 days; after that time, if I wish to be considered for employment, I must submit a new application.

I hereby authorize any former employer, its employees and representatives, or any person listed as a reference to provide any and all information deem appropriate regarding my employment and job performance to La Maestra Community Clinics, and any of its employees, representatives and agents. In addition to authorizing the release of any information regarding my employment, I hereby fully waive any rights or claims I have or may have against any former employer, its employees and representatives, former educational institution, or any person listed as a reference from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure or release of such information by any person or party, whether such information is favorable or unfavorable to me may be provided either verbally or in writing.

If I am hired, I understand that I am free to resign at any time, with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without prior notice. This application does not constitute an agreement or contract for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing are binding on the company unless they are in writing and signed by the employer s designated representative.

 

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.