Employment Application – Brainerd Lakes Surgery Center

Brainerd Lakes Surgery Center Employment Application.

Lakes Surgery Center is an Equal Opportunity Employer. The surgery center does not discriminate because of race, creed, national origin, sexual orientation, disability, age sex, martial status, with regard to public assistance. Our policy is to hire based on your qualifications, experience and performance. Please complete entirely.

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Applicant Information

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Available to Start

Social Security Number

Phone

Desired Salary $

Position Details

Position Applying For

Please List Any Applicable Licensures or Certifications

Are You A Citizen Of The United States?

Have you ever been convicted of a felony?

Education

High School

Address

Did You Graduate

Degree

Start Year

End Year

College

Address

Did You Graduate?

Degree

Start Year

End Year

Other

Address

Did You Graduate?

Degree

Start Year (copy)

End Year (copy)

References

Please list three professional references

Full Name

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone

Full Name

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone

Full Name

Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Relationship

Phone

Previous Employment

Company or Medical Facility

Job Title

Reason For Leaving

Phone

Date Started

May we contact your previous supervisor for a reference?

Supervisor

Date Ended

Company or Medical Facility

Job Title

Reason For Leaving

Phone

Date Started

May we contact your previous supervisor for a reference?

Supervisor

Date Ended

Company or Medical Facility

Job Title

Reason For Leaving

Phone

Date Started

May we contact your previous supervisor for a reference?

Supervisor

Date Ended

Military Services

Branch

Rank at Discharge

Start Date

Discharge Type

End Date

If Other Than Honorable, Explain.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Clear Signature

Date Signed

Save and Resume Later

Proudly owned by Brainerd Lakes Surgeons, L.L.C. and Brainerd Medical Center Inc.

Important Links

Financial Information FAQ Careers Patient’s Bill of Rights Accessibility and Nondiscrimination Notice Advanced Directives

Contact details

13114 Isle Dr,
Baxter, MN 56425 Phone: 218-822-2400 Toll Free: 866-863-2400 Fax: 218-822-2401

Pay Bill Online

Your Medical Information.
We are happy to fulfill your request for release of your medical records.
Print this pdf form and bring it in.

Terms and Conditions

Site Map

Accessibility and Nondiscrimination Notice

Patient’s Bill of Rights

Website by Mixture Web

Advance Directive

For information regarding Advance Directives, please contact your healthcare provider or follow the link below.

https://www.health.state.mn.us/facilities/regulation/infobulletins/advdir.html

Preparing for your Total Joint Replacement

• Register for your preoperative class 218-454-8469.

• Begin your pre-operative exercises as shown in your guidebook.

• Choose your coach.

• Stop Smoking.

• Maintain or achieve a healthy weight.

• Schedule your preoperative physical and any needed lab work.

• Prepare your home- adjust furniture to clear walking paths and remove all throw rugs. Have a comfortable, supportive chair for after surgery.

Medications and supplements to avoid before surgery

Avoid these non-sterodial anti-inflammatory Drugs (NSAIDS)

Actron Caplets
Advil
Advil Migraine
Aleve
Altran
Anapox DS
Ansaid
Arthrotec
Bayer Select Pain Relief
Formula Caplets
Children's Motrin
ClinorilV
Daypro
Diclofenac
Etodolac
Feldene

Fenoprofen
Flurbiprofen
Genpril
Ibuprin
Ibuprofen
Indomethacin
Indocin
Ketoprofen
Ketorolac
Lodine
Meclofenamate
Mefenamic Acid
Meloxicam
Menadol
Midol 1B
Mobic

Motrin IB
Nabumetone
Nalfon
Naproxen
Naprosyn
nuprin
Orudis KT
Oxaprozin
PediaCare Fever
Prioxicam
Ponstel
Relafen
Saleto 200
Sulindac
Toradol
Voltaren

Avoid these Vitamin E Products (and all multivitamins with vitamin E)

Amino-Opt-E
dalpha E
E-complex-600

Aquasol E
E-400IU
Vita-Plus E

Aquavit
E-1000 IU Softgels
All multivitamins

Medicines to Take Instead

You can take acetaminophen and products that contain it. They do not affect your platelets and will not increas your chance of bleeding. Do not take more than 4 grams in one day: very high doses can cause liver damage.