Application Information

Name Hodges, Tammy Sue Primary Phone 220-***-**** [Cell]

Secondary Phone (n/a) Date of Application 06-24-2023 Application ID 243294 Applied to Fairfield Medical Center Email Address adyuhq@r.postjobfree.com Address 330 Trace Drive, apt. 110 City, State, Zip Code,

Country

Lancaster, OH, 43130, USA County Fairfield

Referral Source Internet Career Website Referral Name Next Driver's License

Number

(n/a) Driver's License State (n/a)

License Expiration Date (n/a)

Education

Institution Independence high school,High

School,Columbus, OH, USA, (n/a)

Dates Attended (n/a)

Attended As (n/a) Major/Minor (n/a)

Degree (n/a) GPA (n/a)

Graduated Yes

Employment

Employer Speedway, 9749 Hazelton Etna Rd

sw, Pataskala, OH, 43062, USA, (740)

964-2341

Dates of Employment 05/11/2022 To 05/01/2023

11 Months 20 Days

Job Title / Pay Rate Head cashier/customer service

$13.00/wk

Job Duties Ran register, took care of customer

needs, handled money, put away

merchandise, stocked merchandise,

helped out in kitchen preparing meals

for customers, kept the store clean

and presentable for customers.

Can Contact? Yes

(Dave )

Reason for Leaving Husband passed away

Current Employer No

Employer Speedway, 4232 cemetery Rd,

Hilliard, OH, 43026, USA, (614) 876-

4421

Dates of Employment 02/25/2001 To 05/15/2003

2 Years 2 Months 20 Days

Fairfield Medical Center

Payroll Profile: 0XT57

Application for Dietary Attendant - Part Time - Days - 243294

Generated: (6/25/2023 1:50 AM) Page: 1 of 4

Job Title / Pay Rate Cashier/customer service

$14.00/wk

Job Duties Ran register, helped customers

needs, handled money, performed

transactions, stocked merchandise,

put away merchandise, helped in the

kitchen preparing food for the

customers, kept store clean and

presentable for customers. Helped

wherever needed

Can Contact? Yes Reason for Leaving Moved

Current Employer No

Employer Georges food market, Lockbourne rd.

, Columbus, OH, 43207, USA, (614)

443-1152

Dates of Employment 04/13/1997 To 12/30/1999

2 Years 8 Months 17 Days

Job Title / Pay Rate Head cashier/ food service

$16.00/wk

Job Duties Ran register, took care of customer

needs, performed transactions,

stocked merchandise, out away

merchandise, prepared food in the deli

for service and for customers, kept

store clean and presentable for

customers. Helped wherever needed..

Can Contact? Yes

(Bob gunderson)

Reason for Leaving The business closed doors.

Current Employer No

References

Name Dave S Company Speedway in pataskala, Ohio

Title (n/a) Relationship Former boss

Email Address adyuhq@r.postjobfree.com Time Known (n/a) Phone 614-***-****

Name Charity W Company Speedway in pataskala, Ohio Title (n/a) Relationship Former coworker

Email Address adyuhq@r.postjobfree.com Time Known (n/a) Phone 740-***-****

Name Jenny S Company Speedway in pataskala, Ohio

Title (n/a) Relationship Former supervisor

Email Address adyuhq@r.postjobfree.com Time Known (n/a) Phone 740-***-****

Fairfield Medical Center

Payroll Profile: 0XT57

Application for Dietary Attendant - Part Time - Days - 243294

Generated: (6/25/2023 1:50 AM) Page: 2 of 4

Questions

Question Group 1

Type of employment desired? (Status): Full Time; Part Time What shifts are you willing to work? (Shift): Days Where did you hear about this job? Paycomonline.net When are you available to start work? 07-05-2023

Minimum Salary Desired: 17

What is your highest level of education? Got my diploma Do you have a license, registration, or certification for this position? No If yes, please list the following: Name, State issued, Number, Issued date, Expiration Date, Type

No certificate

Were/Are you a member of the U.S. Armed Forces? No Are you a U.S. Citizen or an alien authorized to work in the United States? Yes Are you 18 years of age or older? Yes

Have you ever been employed at our hospital? If yes, please list previous department, job title, manager and what your name was at the time of employment with FMC.

No

Do you have any relatives employed at our hospital? No Have you ever been convicted of a Felony, Crime, or Misdemeanor? If yes, please provide details.

Yes in 2009 I have settled all my

expectations and complete all my duties.

Have you been sanctioned, cited, reported, or excluded from participation in Medicare, Medicaid, or any other healthcare related law or regulation? No

Statement

Application for Employment

Fairfield Medical Center offers equal employment opportunity to all applicants for employment and to all employees regardless of race, color, religion, sex, national origin, age, citizenship, sexual orientation, ancestry, marital status, pregnancy, physical or mental disability, medical condition or status as a disabled veteran or a veteran of the Vietnam era or any other characteristic protected by applicable law. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of accurate and factual employment information. Fairfield Medical Center

Payroll Profile: 0XT57

Application for Dietary Attendant - Part Time - Days - 243294

Generated: (6/25/2023 1:50 AM) Page: 3 of 4

Acknowledged

Yes

Signature

Tammy Hodges [06/25/2023]

Fairfield Medical Center

Payroll Profile: 0XT57

Application for Dietary Attendant - Part Time - Days - 243294

Generated: (6/25/2023 1:50 AM) Page: 4 of 4

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