Application For Employment

Personal Information

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Any offer of employment is conditioned upon completing form 1-9 and providing the appropriate documents for identity and work authorization.

Employment Desired

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Yes   No  

If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by state or federal law.

Work Prefrences - check all that apply

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Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday  
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Full Days   Morning Only   Afternoon Only   Nights   Live-in  
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Private Homes   Hospitals   Nursing Homes   Branch Office  
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Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
Yes   No  
RN   LPN   LVN   CNA   HHA   PCA  
OTHER  
Internet   Newspaper   Employee   Walk-in  
Yes   No   If yes, when?
Yes   No   If yes, when?
Yes   No   If yes, Policy number:

Education

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Yes   No  
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Yes   No  
Yes   No  
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Yes   No  

Employment History (List last employer first, then previous employer, etc.)

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Yes   No  
Yes   No  
Yes   No  

Resume

CAREFULLY READ EACH STATEMENT BEFORE CLICKING ACCEPT

I certify that all of the information provided in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background, credit history check, and drug test, as applicable. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

Further, I understand and agree that my employment is for no definite period, and may, regardless of the date of payment of my wages and salary be terminated at any time without any previous notice.

I have read, understand, and agree to the above statements.

I Accept *