Download Application

Download, print and complete the Application for Employment to apply for a position offline.

Serving 36 South Carolina Counties!

We are now serving Laurens County due to requests made by families in need!

Florence Georgetown Charleston
Lee Horry Dorchester
Darlington Richland Berkeley
Dillon Newberry Colleton
Marion Lexington Clarendon
Williamsburg Kershaw Orangeburg
Marlboro Chesterfield York
Chester Fairfield Lancaster
Sumter Laurens County Greenville
Greenwood Union Aiken
Abbeville Saluda Edgefield
Spartanburg Calhoun Jasper

Application for Employment

Nightingale's Nursing & Attendants is currently hiring!

You must complete and submit an application for employment to be considered. All fields marked with an asterisk (*) are required.

If employed the following must be provided to Nightingale's Nursing & Attendants:

  • Drivers License
  • Social Security Card
  • Proof of car insurance
  • Driving Record
  • Recent PPD (TB test record)
  • Any Certificates (CPR, etc)
  • Nursing License (if applicable)

Personal Information

Position Applying For *  
Last Name *  
First Name *  
Maiden Name/Alias
DOB (MM/DD/YY)
Street Address *  
City *  
State *   Zip *  
Telephone * ex: 555-555-5555  
Cell Phone ex: 555-555-5555
Emergency Phone No. * ex: 555-555-5555  
Email Address *    
Salary Required (per hour) $
Current Employer & position
Current Salary $
Referred by
Ever Applied Before *   If yes, when?
Special Training?
Where? When?

Education

  Location Years
Attended
Did You Graduate?
High School
College
Vocational / Adult Education

General Information

Please summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. *

 

Former Employer (List last one first)

Dates (MM/DD/YY) From To / Present
Employer Name
Employer Address
Telephone
Salary $
Position
Reason for leaving (be specific)

Former Employer (2)

Dates (MM/DD/YY) From To / Present
Employer Name
Employer Address
Telephone
Salary $
Position
Reason for leaving (be specific)

Former Employer (3)

Dates (MM/DD/YY) From To / Present
Employer Name
Employer Address
Telephone
Salary $
Position
Reason for leaving (be specific)

Character References (other than relatives or previous employers)

Name *
     
Phone No.(s) *
ex: 555-555-5555
     
Years
Known*

     
How
Acquainted*

     

Other Information

Reasons you want to work for Nightingale's *  
How did you hear about Nightingale's *  
List your personal goals: *  

Misc.

I certify that I have dependable transportation *  
I certify that I have access to a telephone for easy communication *  
I certify that I have a valid driver's license *  
I certify that I have an insured vehicle *  
Have you been convicted of a crime within the last 10 years ? *  
If yes, please describe:
I understand that my job is not complete until I turn in my Care Plan/Time Sheet and agree to do so prior to receiving payment from Nightingale's *  
I understand that dependability is extremely important to home care. I will notify the office at least 3 days prior to requesting time off. *  
I understand that clients have the option of refusing my services at any time and this may be of no fault of Nightingale's *  
I understand that I will be required to participate in 10 hours of in service training annually and will attend mandatory meetings. *  
I certify that I have no prior mental or physical impairments that will affect or limit my work capabilities for any assignments. *  
I agree to accept responsibility for working safely. *  
I agree to never accept money or tips of any kind from a client without Nightingale's permission. *  
I understand that asking to borrow money from a client is grounds for immediate termination *  
I understand that entering false time on timesheets may be fraud and is cause for termination *  
I certify that if I have ever had a workman's compensation case against an employer for personal injury that I am 100% cleared by my physician to return to work *  

Counties

Nightingale's provides services to the following Counties. Please select every county in which you are willing to work:

Tip: To select multiple locations, hold down the Ctrl key while clicking each county.

 
I am willing to work within a 50 mile radius of the selected counties  

Resumé

Attach resumé:

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of my background through SLED checks and all other information provided and release Nightingale's from all liability from any damage that may result from using such information. I also understand and agree that no representative of Nightingale's has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing, unless in writing and signed by an authorized Nightingale's representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans With Disabilities Act (ADA) and other relevant federal and state laws.
Do you agree with the authorization statement?