Blanchard Valley Medical Associates, Inc.
Employment Application

Blanchard Valley Medical Associates is an Equal Employment Opportunity Employer. It is the philosophy, intent, and commitment of Blanchard Valley Medical Associates to adhere to a policy of equal employment opportunities for all applicants and employees without regard to race, color, religion, sex, age, national origin, veteran status, pregnancy, mental or physical disability or any other status protected by law.

When completing this application, do not leave any questions blank. Do not substitute "see resume" for any requested information.

THIS APPLICATION WILL REMAIN ACTIVE FOR THREE (3) MONTHS UPON SUBMISSION.

Tell Us About You

Are you legally eligible for employment in the United States?

Are you currently employed?

Are you related to anyone employed at BVMA?

Tell Us About Your Education and Certifications

Did you graduate from high school or obtain a GED?

College or Post-High School Certification Programs

Did you graduate and/or complete this program?

Did you graduate and/or complete this program?

Tell Us What You're Looking For

Check all positions for which you are qualified and are interested:












How many hours per week would you like to work? Check all that you would consider.



What is your minimum salary requirement range (hourly)?





Complete this amount if you chose "other" above.

Tell Us About Your Work History

Please list your work history starting with your present or most current position. 

Who Can Tell Us About Your Professional Experience?

May we contact your current employer?

Reference 1

Reference 2

A Couple of Important Questions We Need to Ask

Have you ever been convicted of a felony or misdemeanor, whether sealed or unsealed, (other than minor traffic violations)?
NOTE: A conviction will not necessarily be a bar to employment. Factors such as date, nature and number of offenses, age at the time of offense and rehabilitations will be considered.

Do you ever smoke or use any tobacco products (regularly or socially)? (This includes, but is not limited to, cigarettes, e-cigarettes, cigars, pipes, chewing tobacco, etc.)

What Else Would You Like Us to Know About You?

Want Us to See Your Resume?

If you'd like, upload your resume here!
Resume uploads must be in PDF format.

By clicking the submit button below, I certify that the facts in this Application are true and complete to the best of my knowledge and understand that if I am employed, any statements I have falsified on this Application shall be grounds for dismissal.
I also understand that, if selected for an in-person interview, I will be asked for my original signature to certify the same; which will be attached to my printed Application information.