Genesee Health System

Genesee Health System Is An Equal Opportunity Employer.  We do not discriminate on the basis of religion, race, color, national origin, sex, disability, age, marital status, height, weight, arrest record, genetic information or sexual orientation.

If you have a disability which impairs your ability to apply for a position, please be advised that this office will, upon request, provide assistance in reading or completing the application, as needed.

Application for Employment

Please complete all sections.

Personal Information








Position/Criminal/RR Information



  • Have you ever been convicted of any felony or misdemeanor, not including civil actions, but including juvenile offenses?

Educational Information

License/Certification (Please attach a copy)

Paid Employment Experience

Please Note: Resume can be attached in place of completing this section, but must include month/year dates of employment and full time/part time status.
  • Occasionally, the form of an application makes it difficult for an individual to adequately summarize his/her complete
    background.  To assist us in properly assessing your qualifications, use the space below to present any additional
    information relevant to employment with Genesee Health System
    .  (Include experience, skills,
    hobbies, volunteer work, etc. not covered above.)

Military Service


Technical Qualifications



    Professional References (Not Relatives)

    Additional Applicant Information (Optional)










    1. Understand that if I am selected for employment, evidence of U.S. citizenship or U.S. permanent resident status must be
      provided to the Agency.
    2. Certify that the information contained in this application is true to the best of my knowledge and belief. I further
      understand that, if employed, any misrepresentation of fact in this application may result in my discharge.
      1. Acknowledge and authorize Genesee Health System to do a criminal background check
        to verify information provided on this application for employment.
    3. Authorize my previous employer (s) to release to Genesee Health System any information with
      respect to my employment with said previous employer (s) as GHS may request, including copies thereof.
    4. Acknowledge and agree that, if employed, my employment is “at will” or subject to termination at any time during
      my probationary period for any reason or no reason at all by either the employer or myself. I further understand
      that no oral statement or representation made before or during my probationary period will change, modify or
      amend that “at will” nature of my employment. This provision applies to current employees unless provisions
      of applicable bargaining agreements provide otherwise.
    5. Acknowledge that non-privileged information contained in this application may be publicly disclosed upon
      a request under the provisions of the Freedom of Information Act, unless I am able to demonstrate through
      written request at the time of application that the release of this information represents an unwarranted
      invasion of privacy.