VERTEX

employmentbanner
Application for Employment

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:

1. Drivers License
2. Social Security Card
3. Proof of car insurance
4. 10 Year Driving Record
5. Recent PPD (TB test record)
6. Any Certificates (CPR, etc)
7. Nursing License (if applicable)
8. SLED background check
9. Verifiable character references

Generated with Mad4Joomla Mailforms Version 1.1.9.1
* Required information.
Last Name *
Maiden Name
First Name *
Street Address *
City *
State *
Zip *
Mailing Address *
Position Applying For *
Primary Telephone *
Alternate Telephone
Emergency Phone No *
Salary Required (per hour) *
Current Employer
Current Position
Current Salary
Referred By *
Ever applied here before? If yes, when?
Special Training
Special Training (Where?)
Special Training (When?)
High School *
High School Location *
Years Attended High School *
High School Diploma?
College you attended
College Location
Years Attended College
College Diploma?
Vocational/Adult Education
Vocational/Adult Education Location
Years Attended Vocational/Adult Education
Vocational/Adult Education Diploma?
Please provide your work and training background.
Former Employer 1 Name
Former Employer 1 Address
Former Employer 1 Reference Name
Former Employer 1 Reference Telephone
Former Employer 1 Salary
Former Employer 1 Position
Former Employer 1 Date Range
Former Employer 1 Reason for Leaving
Former Employer 2 Name
Former Employer 2 Address
Former Employer 2 Reference Name
Former Employer 2 Reference Telephone
Former Employer 2 Salary
Former Employer 2 Position
Former Employer 2 Date Range
Former Employer 2 Reason for Leaving
Former Employer 3 Name
Former Employer 3 Address
Former Employer 3 Reference Name
Former Employer 3 Reference Telephone
Former Employer 3 Salary
Former Employer 3 Position
Former Employer 3 Date Range
Former Employer 3 Reason for Leaving
Character Reference 1 Name *
Character Reference 1 Phone Number(s) *
Character Reference 1 Years Known *
Character Reference 1 How Acquainted *
Character Reference 2 Name *
Character Reference 2 Phone Number(s) *
Character Reference 2 Years Known *
Character Reference 2 How Acquainted *
Character Reference 3 Name *
Character Reference 3 Phone Number(s) *
Character Reference 3 Years Known *
Character Reference 3 How Acquainted *
Reasons you want to work for Nightingale's Nursing & Attendants *
How did you hear about Nightingale's Nursing & Attendants? *
List your personal goals *
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 to convicted of a crime, please describe
Any felony convictions?
I understand that my job is not complete until I turn in my Care Plan/Time Sheet *
I understand that dependability is extremely important to home care. *
I understand that clients have the option of refusing my services at any time. *
I understand that I am required to participate in service training annually. *
I certify that I have no prior mental or physical impairments. *
I certify that if I am 100% cleared by my physician to return to work. *
I agree to accept responsibility for working safely. *
I agree to not accept money/tips from clients without Nightingale's permission *
I understand that asking a client for money is grounds for termination. *
I understand that I cannot moonlight with clients while employed by Nighingales *
1. Which Counties are you willing to work in?
2. Which Counties are you willing to work in?
3. Which Counties are you willing to work in?
I am willing to work within a 50 mile radius of the selected counties.
I certify that the facts contained in this application are true and complete
Signature - Entering your name here as proof of signature
You can attach your resume here

Hover over the left image and enter the security code into the right textfield.
Nightingales Nursing and Attendants © 2011      Privacy policy