Glen Rose Medical Center


2 ways to apply

1. Fill in the required fields on the application below and click the SUBMIT button.
Your application will be emailed to us for review.

2. Or, fill in this application and print out. Mail to:

Human Resources
Glen Rose Medical Center
P.O. Box 2099
Glen Rose, TX 76043

*Required Fields
Cover Letter (Optional):  
*First Name:  
*Last Name:  
Middle Initial:  
Maiden Name:  
*Present Address:  
*Zip Code:  
*Phone Number: ( i.e. ### - ### - ####)
*Social Security Number:  ( i.e. ### - ## - ####)
*Email Address:  
Are you a U.S. Citizen?   Yes   No
If No, are you legally allowed to work in the U.S.?   Yes   No
If Yes, how long?  
If employment is offered, can you submit a birth certificate, social security card, certificate of U.S. citizenship, or verification of your legal right to work in the U.S.?   Yes   No
If employment is offered, can you produce a personal identification such as a U.S. passport, a driver's license, or photographic identification card issued by the State?   Yes   No
What date are you available for employment?  
Have you ever applied for a position with Glen Rose Medical Center?     Yes   No
Location of Previous Application?  
Date of Previous Application?  
  Name of School Address of School Degree(s) Date Attended
High School
Graduate School
What type of employment do you want?   Full-time   Part-time   Summer
Will you work shifts?   Yes   No
For what type of position are you applying?  
License type: (if applicable)  
What is your minimum salary requirement?  
(List below current and previous employers, starting with current or latest employer first)
Date (mm/yy) Employer Name,
Address & Phone
Salary Position Reason
for Leaving
As an applicant for employment, I understand the following:
  • All information is subject to verification.
  • Any misrepresentation or falsification of information requested here will be cause for rejection of this application or for subsequent discipline up to and including my dismissal from employment.
  • If my application for employment is accepted, the effective date of my employment shall be the time I actually begin to work. If I am employed, I agree to comply with and be bound by the safety and health rules and regulations of Glen Rose Medical Center.
  • My employment is not guaranteed for any term, and my employment may be terminated by the company or myself for any reason.
  • No management official is authorized to make any oral assurance or promise of continued employment.
  • I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying such information.
  • I agree to submit to any lawful drug testing that may be required as a condition of employment and understand that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge.
  • I understand that according to federal law all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identity and U.S. citizen status, or, if aliens, their legal authorization to work in the U.S. Therefore, I realize that any offer of employment would be contingent upon my ability to produce the required documentation within the time period required by law.

This Company will not discriminate against any employee or applicant for employment because of age, religion, sex, race, color, national origin, disability, non-job-related handicap, or because they are a disabled veteran or Vietnam era veteran. Answers to application questions will be utilized for applicable, job-related information only.

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