International Medical Corps | Join Our Team: Employment at IMC


EMPLOYMENT APPLICATION (A) IMPORTANT NOTICE: THIS IS A VERY SIGNIFICANT DOCUMENT. YOU SHOULD BE VERY CAREFUL AS YOU COMPLETE IT. ANSWER EACH ITEM ACCURATELY AND COMPLETELY. FAILURE TO DO SO MAY RESULT IN YOUR NOT BEING CONSIDERED FOR THE POSITION OR IN YOUR TERMINATION IF INACCURATE OR OMITTED INFORMATION IS DISCOVERED AFTER YOUR EMPLOYMENT HAS BEGUN. ALL APPLICATIONS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN , MARITAL STATUS, AGE, RELIGION, DISABILITY OR VETERAN STATUS AS PRESCRIBED BY LAW.

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General Information
Name:				Social Security #:
First:*		Last:*			Middle Initial:
Email Address:*			Password (create own):*		Confirm Password:*


Current Address:*		City:*		Province or State:*
Zip or Postal Code:*		Country:*

Current Telephone #:*			Mobile Telephone #:


Permanent Address:*		City:*		Province or State:*
Zip or Postal Code:*		Country:*

Permanent Telephone #:*


Alternate Telephone #:
Education:*
Job Ref. # (if applicable)
Employee Referral (name of person):

Years of emergency, relief, public health for developing country, work:
Available for Assignment Term of*
How did you learn of the open position?:*
Please Specify:

Fluency Level (1): (SHIFT or CTRL for multi selection)
Language Skills (2): (SHIFT or CTRL for multi selection)
Fluency Level (2): (SHIFT or CTRL for multi selection)
Language Skills (3): (SHIFT or CTRL for multi selection)
Fluency Level (3): (SHIFT or CTRL for multi selection)
Language Skills (4): (SHIFT or CTRL for multi selection)
Fluency Level (4): (SHIFT or CTRL for multi selection)



Salary:
Current Job Title:
Type:
Availability Date:*
Resume:*	(Please cut and paste your Resume here)


Passport Information
Passport #:			Country of Issue:
Date Issued: Month / Day / Year			Date Expired: Month / Day / Year

Previous IMC Experience
Ever applied to IMC before?			When: Month / Day / Year
Ever worked for IMC before?			Where:
Was termination voluntary or involuntary?:
Exact reason(s) for leaving:
Name of last supervisor at IMC:

Additional Information
Are you able to perform the essential functions of the job for which you are applying with or without accommodations?
Do you take any illegal drugs?
Describe fully:
Do you use alcohol to the extent that it would impair your job performance?
Describe fully:
Is there any reason why you would not be able to fully conform to all attendance requirements?
Describe fully:
Have you ever been convicted of (or pleaded guilty or nolo contendere to) a crime within the past seven years? (Do not identify marijuana-related misdemeanor convictions occurring more than two years ago or convictions for which the criminal record has been expunged, sealed or eradicated by the court, or misdemeanor convictions for which any probation has been completed and the case dismissed by the court.)
# of times
Did the conviction(s) (or guilty or nolo contendere plea) result in imprisonment?
# of times
Explain each conviction (and guilty or nolo contendere plea) fully. (A conviction (or guilty or nolo contendere please) will not necessarily disqualify an applicant.)
Are you currently charged with an unresolved criminal charge (a charge which has not yet resulted in a plea, trial, or a dropping of the charge, or for which you are out on bail or on your own recognizance pending trial)?
Explain fully. (A charge will not necessarily disqualify an applicant.)

Employment History
Present or Last Employer
Name:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Starting Date: Month / Day / Year			Leaving Date: Month / Day / Year
Starting Salary: US $ (Per month)			Final Salary: US $ (Per month)

Job Title:			May we contact immediate supervisor?
Name and title of immediate supervisor:
Name		Title
Telephone #:		Email:
Description of Work:
Was termination voluntary or involuntary?
Exact Reason(s) for leaving:

Former Employer
Name:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Starting Date: Month / Day / Year			Leaving Date: Month / Day / Year
Starting Salary: US $ (Per month)			Final Salary: US $ (Per month)

Job Title:			May we contact immediate supervisor?
Name and title of immediate supervisor:
Name		Title
Telephone #:		Email:
Description of Work:
Was termination voluntary or involuntary?
Exact Reason(s) for leaving:

Former Employer
Name:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Starting Date: Month / Day / Year			Leaving Date: Month / Day / Year
Starting Salary: US $ (Per month)			Final Salary: US $ (Per month)

Job Title:			May we contact immediate supervisor?
Name and title of immediate supervisor:
Name		Title
Telephone #:		Email:
Description of Work:
Was termination voluntary or involuntary?
Exact Reason(s) for leaving:


References
Please note at least two references: current or former direct supervisors (do not list relatives).
Name:		Position held:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Telephone #:		Email:


Name:		Position held:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Telephone #:		Email:


Name:		Position held:
Address:		City:		Province or State:
Zip or Postal Code:		Country:

Telephone #:		Email:



Additional Questions
Please answer the questions below:
Language: English
Language: French
Language: Spanish
Language: Portuguese
Language: Arabic
Other Languages (please indicate read, write, speak)

Do you have experience in managing international relief/development organizations?
Do you have experience in senior management?
Do you have experience in project management ?
Do you have experience in technical/medical supervision?
Do you have experience in international human rights monitoring?
Do you have experience in site security?
Do you have experience in information systems security?
Do you have experience in field needs and impact assessment?
Do you have experience in field program/organization evaluations?
Do you have experience in policy development/evaluation?
Do you have experience in research?
Do you have experience in report writing?
Do you have experience in training delivery / facilitation?
Do you have experience in psychological counseling for stress, trauma, torture, rape?
Are you a medical doctor?
Do you have experience as a para-medic?
Are you a licensed nurse?
Are you a licensed therapist: P.T., R.T., O.T.?
Are you a nurse-practitioner?
Are you a pharmacologist?
Do you have experience in public health?
Do you have experience in hospital administration?
Do you have experience in social work?
Do you have experience in negotiation?
Do you have experience in field communication: training users and setting up systems?
Do you have experience in financial management and auditing?
Do you have experience in managing international field missions?
Additional Comments


EEO Information
Provision of the following information is entirely voluntary and kept separate from your resume. In accordance with federal government guidelines, Human Resources use the data for statistical purposes only. A decision to provide or not provide such information will have no effect on the company's employment decision, and the information will not be given to the hiring manager. Applicants are considered for positions without consideration of their race, color, religion, sex, national origin, sexual preference, age, marital status, medical condition, disability or other legally protected status. *Click here for definitions
Language Skills (1):
Gender (Optional):
Voluntary Self Designation (Optional):
Nationality

Authorization
Please read carefully and answer each paragraph before signing.
I declare under penalty of perjury that the facts contained in this application or any resume or other documentation submitted are true and complete to the best of my knowledge. I understand that any false information or significant omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment, if discovered at a later date.*

I agree to immediately notify IMC if I should be convicted of any crime while my job application is pending or during my period of employment, if hired.*

I understand that IMC may be requesting information or a report to contain pertinent information permitted by law from various local, state, federal agencies, and former employers. I understand that the report may include information as to my character, general reputation, personal characteristics, work habits, performance and experience, along with reasons for termination of past employment from previous employers. I voluntarily and knowingly authorize the release of all information requested by IMC.*

I authorize the investigation of all statements contained in this application (and accompanying resume) and further authorize any person, school, current employer (except as expressly noted), past employer(s) and organizations named in this application form (and accompanying resume) to provide IMC information and opinion that may be useful in making a hiring decision. I release all informants from all liability for any damage that may result from furnishing information and opinion (which is truthful or made in good faith) to you.*

I understand that, if hired, I may not hold other employment, nor engage in other activities that create a conflict of interest with my position with IMC, unless given permission in writing by the executive office.*

Agreement for At-Will Employment
If I become employed, in consideration of my employment, I agree that my employment will be At-Will, and may be terminated with or without cause, and with or without notice, at any time at the option of myself or IMC. Only the President and CEO of IMC has the authority to enter into an employment agreement for a specified period of time or termination only for cause, and such agreement must be in writing. I understand and acknowledge that this constitutes the entire agreement between me and IMC regarding the term of my employment and supersedes any other oral or written agreement.*

Compliance with Rules
If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of IMC.*

Signature*