CONTRACT APPLICATION-REVISED 1-7-2025.pdf

This document is a Contract Application for employment at East Mississippi State Hospital, located in Meridian, Mississippi. The multi-page application form requires detailed personal information, educational background, work history, and professional experience. The application includes sections for demographic data, race and veteran status, educational credentials, work history, and employment experience. Applicants must provide comprehensive details about their professional background, including previous employers, job duties, salaries, and supervisory responsibilities.

The application includes a certification section where applicants attest to the truthfulness of their submitted information and authorize the hospital to verify their background. An additional Authorization form allows East Mississippi State Hospital to request and receive information about the applicant from other organizations, releasing those organizations from liability in providing such information. The document is designed to collect extensive professional and personal details to support a thorough hiring process for potential contract employees at the state hospital.