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Work @ RMC

Personal Information

Please provide your first name.
Please provide your middle initial.
Please provide your last name.
Please provide your home address.
Please provide your home city.
Please provide your home state.
Please provide your home zip.
Please provide your mailing address.
Please provide your mailing city.
Please provide your mailing state.
Please provide your mailing zipcode.
Please provide a valid home phone number.
Use the format xxx-xxx-xxxx
Please provide a valid mobile phone number.
Use the format xxx-xxx-xxxx
Please provide a valid email address.


If you are under 18 can you furnish a work permit?
Are you legally authorized to work in the U.S.?
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?
Have you ever filed an application here before?
Have you ever been employed here before?

Employment Desired

What day could you start?
Status Desired
Check all that apply.
Days Available For Work
Check all that apply.
Shifts Available to Work
Check all that apply.
Which RMC sites are you able to work at:
How did you hear about us?

List names of relatives employed by RMC

Work Experience

Please list last 10 years of work experience beginning with the most recent position.

May we contact your present employer prior to extending an offer of employment?

Education & Training

High School

Did you Graduate?

College University or Technical

Did you Graduate?

College University or Technical

Did you Graduate?

Professional Skills & Licensure Information


Please list any licenses or certificates

(Include Driver's License only if job related)

Foreign Language Skills

RMC, in compliance with California State Law, maintains a directory of employees who are able to translate or sign.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, except as expressly stated in writing herein. I understand that falsification, omission, or misstatement of information may result in refusal to hire or if hired, dismissal from employment, regardless of my hire or length of employment.

I agree that I will submit to a pre-employment medical examination, which includes a drug screen, alcohol screening examination, and a Tuberculosis (PPD) test, after receiving a conditional offer of employment. The examination will be at no cost to me. I understand that my offer of employment is contingent upon my successful completion of this medical examination, drug screen, alcohol screening, and PPD test.

I understand that after receiving a conditional offer of employment, RMC will conduct an inquiry into my criminal conviction history to the extent allowed under applicable California and federal law. I understand that such an inquiry will not include (1) arrests that did not result in a conviction; (2) information concerning a referral to or participation in a criminal diversion program; (3) convictions for most marijuana possession offenses more than two years old; (4) convictions that have been judicially dismissed or ordered sealed pursuant to law; (5) juvenile criminal history information; (6) misdemeanor convictions for which no jail sentence can be imposed; (7) infractions or misdemeanor convictions for which three years have passed since the date of the conviction; or (8) felony convictions for which seven years have passed since the date of conviction.

I understand that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing. RMC maintains an employment at-will policy that permits the employee or RMC to end the employment relationship at-will, with or without cause, for any reason, at any time. I understand that no individual of the company has the authority or legal ability to modify the at-will nature of the employment relationship. This represents an integrated agreement with respect to the at-will nature of the employment relationship and cannot be changed except by written agreement signed by the employee and the RMC President.

I understand that RMC is committed to a policy of equal employment opportunity for applicants and employees. Employment decisions will comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967, The Americans with Disabilities Act of 1990, the Immigration and Nationality Act, and any other applicable State and Federal Laws. I understand this application will be retained for no more than one (1) year.

Riverside Medical Clinic