Thank you for your interest in working at our hospital. We appreciate your application and look forward to the possibility of your joining our team. This sheet is for your information. Please tear it off and keep it for your reference.

Please complete the attached application and authorization for release of information forms. Please print all information so it may be easily read. Be certain all forms are completely filled out and signed. Use the abbreviation of “N/A” if a particular provision or section in the form is not applicable to you. Incomplete applications will not be considered.

Your application will remain in our active files for a period of one year. Should an appropriate opening occur, your application will be reviewed along with others. It is not necessary for you to contact this office regarding any job opening after you have completed your application. If you are among the most qualified applicants for a position an interview will be arranged. Please notify us in writing if your address or telephone number changes.

Employment decisions are made solely on the basis of qualifications to perform the work for which you are applying. Qualifications include education, training and work experience. Credentials and experience will be verified through schools, former employers and licensing/certification agencies, if applicable. As an Equal Opportunity Employer, decisions to hire and promote are made without regard to race, color, creed, national origin, sex, physical or mental handicap (unrelated to ability to do the job), or age (as defined by law).

All applicants may email their application to, fax to 806-349-9387, or they may be mailed to:

Hereford Regional Medical Center
540 West 15th Street
Hereford, TX 79045

Attn: Human Resources Department.

We appreciate your cooperation.

Application for Employment

    Position(s) applied for:

    First Name

    Last Name

    Middle Name




    Zip code


    Home #

    Social Security Number

    If you are under 18, and it is required, can you furnish a work permit?

    If no, please explain

    Have you ever been employed here before?

    Are you legally eligible for employment in this country?

    Date available for work

    Type of employment desired

    Are you able to meet the attendance requirements of the position?

    Have you been convicted of a crime in the last seven (7) years?

    If yes, please explain

    Driver's license number