Online Job Application Form

To be considered for employment by Memorial Hospital of Lafayette County, please complete the online employment application form below and click the "Submit Application Form" at the bottom.  If you have any questions, please call (608)776-4466.

Items marked with an asterisk (*) are required.

Applicant Information
High School
College or University
Other Education

Please list three professional references.

Reference #2
Reference #3
Reference #1
Previous Employment
Second Employment Description
Third Employment Description
First Employment Description
Registrations or Licenses
Second Registration or License
Third Registration or License
First Registration or License
Date and Agreements