Employee Application

Click here for a printable version of this application.

Are you 18 years of age or older?

Do you have the legal right to work in the U.S.?

Have you ever been convicted, pled guilty, or pled no contest to a crime other than a minor traffic violation? Answering "yes" is not an automatic bar to employment.

Have you ever been excluded, disbarred, or suspended from participating in a federally funded health care program?

Have you ever been discharged, or resigned in lieu of being discharged by an employer?

New Field

Have you ever worked for Health One Alliance?

Have you ever applied for a job with Health One Alliance?

Did you Graduate?

Did you Graduate?

Did you Graduate?

Did you Graduate?

Have you served in the military?

May we contact your present employer for a reference?

Do you type?

6 + 9 =


Health One Alliance, LLC is an Equal Opportunity Employer and welcomes applicants to apply for available positions.  Part of our philosophy at Health One Alliance is our commitment to our Foundational Values of Customer Focus,  Competency, Compassion, and Cost Effectiveness. Below are our Values Statement, Standards Summary, and our  Beliefs outlining this commitment. By completing and signing this application, you are willing and committed to  upholding these Values, Standards, and Beliefs should you become employed with Health One Alliance, LLC.

Foundation of Values:
Customer Focus
Cost Effective

Specific Values:
Dignity and Respect – To treat co-workers and business associates with the highest regard.
Integrity – To maintain the highest standards of behavior, encompassing honesty, ethics, and reliability.
Service – To provide outstanding and compassionate care.
Innovation – To continually search for new and better ways to provide the best health care to the community.
Teamwork – To work together to achieve more than each could achieve alone.


Attitude – We believe we are here to serve our customers. 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 – While we are on duty, we will first consider our customers’ 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 a clean and neat environment free from clutter.
Communication – We must listen attentively to our customers in order to understand fully their needs. Close attention  should be given to both verbal and non-verbal messages. Our messages to customers should be delivered with  courtesy, clarity, and care.
Sense of Ownership – We must take pride in what we do, feel responsible for the outcomes of our efforts, and
recognize our work as a reflection of ourselves.
Commitment to Co-Workers – We are linked to one another by a common purpose: to serve our clients and our  community. Our co-workers, therefore, are our teammates. They deserve our respect.
Environment – The appearance of our facilities and workspaces conveys our values and respect for others. The facility  will be clean, orderly, safe, and comfortable for co-workers, clients, and business associates.
Customer Waiting – We recognize that our customers’ time is very valuable. We strive to provide our customers  with prompt service, always keeping them informed of delays and making them comfortable while they wait.
Safety Awareness – Safety is the responsibility of all employees. Ensuring an accident-free environment is part of  your job performance. Accidents are the results of actions and attitudes that you can help eliminate.


• We believe our employees are our most valuable resource.
• We believe in providing an environment where employees:
• Are treated fairly and with respect;
• Can be recognized and rewarded for their individual contribution and feel a sense of accomplishment and  pride in their work;
• Can feel free to express their ideas and concerns and are encouraged to participate and feel a part of the  organization;
• Have opportunities through education and advancement to reach their maximum potential;
• Every employee should realize that there must be an individual and collective responsibility to those we  serve.
• We believe unselfishness and teamwork are vital to the success of the company.
• We believe in fair and consistent application of the policies, procedures, and the Standards of the company.
• We believe in results-oriented management and encourage creativity and initiative that supports the mission of  the organization.
• We believe management must be responsible stewards of its resources in a manner, which ensures the financial  viability of the company.



I certify that the information given by me in this application, accompanying resume, or any attachments I have supplied, is true, correct, and complete to the best of my knowledge. I understand and acknowledge that any misrepresentation, omission, falsification or failure to disclose pertinent information will be cause for immediate dismissal. I understand that if the results of an investigation are not satisfactory for any reason, further consideration or actual employment of Health One Alliance, LLC (HOA, LLC) may be terminated immediately without obligation or liability to me other than payment at the rate agreed upon for service actually rendered, if any.

I authorize and consent to my current and prior employers, educational institutions and persons or organizations named in this application (or accompanying resume) to release any information to HOA, LLC, that may be required to make an employment decision. This authorization will serve as a release of any and all information and for this purpose, a photocopy shall be considered an original and valid.

After a conditional offer of employment has been made, I agree to submit to a medical examination as a condition of employment. If requested, I also understand that I may be required to undergo a drug and alcohol test. I understand that my employment is contingent upon the satisfactory passing of the test. Therefore, a positive result, the alteration or tampering with the test or the result, or my refusal to take the test will result in my offer of employment being revoked. I consent to a pre-employment drug screen and hereby authorize the release of the results of any testing or examinations conducted to Health One Alliance, LLC (HOA, LLC), it’s officers and designees.

I understand that employment is subject to (1) the policies and regulations of HOA, LLC, and (2) submitting documentary proof of my eligibility to work in the United States. I understand that nothing contained in this employment application or in the granting of an interview, and no HOA, LLC policies, procedures, or handbooks that I might receive are intended to create an employment contract between HOA, LLC and me for either employment or the providing of any benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon HOA, LLC unless made in writing to me by an authorized HOA, LLC representative. I understand that my employment with HOA, LLC is At-Will. I understand that if I am employed by HOA, LLC, I may terminate at any time for any reason and that HOA, LLC retains an identical right.

This application must be completed and signed to be considered. It becomes inactive after three months. If you are not contacted within that time period, you must reapply to be considered.