Visiting Nurse Association - Careers- Job Openings

Name:

Referred by:

Home Phone:       (example: 555-555-5555)

Business Phone:       (example: 555-555-5555)

Address:

City:

State:

Zip:

Email:

Have you been employed here before?   Yes   No

If yes, when?      (MM/DD/YY to MM/DD/YY)

Are you either a US. citizen or alien authorized to work in the U.S.?    Yes   No

Date available to work:      (MM/DD/YY)

Are you employed now?   Yes   No

If yes may we inquire of your present employer?    Yes   No

If no, please explain:

Type of employment desired:   (ex. full-time, part-time)

Employment History

One

Employer:

Telephone Number:       (example: 555-555-5555)

Address:

Job Title:

Start and ending dates:   (MM/DD/YY to MM/DD/YY)

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities:

Hourly rate/salary

Starting Rate:

Final Rate:

Reason for leaving:

Two

Employer:

Telephone Number:       (example: 555-555-5555)

Address:

Job Title:

Start and ending dates:   (MM/DD/YY to MM/DD/YY)

Immediate supervisor and title:

Summarize the nature of work performed and job responsibilities:

Hourly rate/salary

Starting Rate:

Final Rate:

Reason for leaving:

Skills & Qualifications

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Education:

High School:

Years Completed:

Course of study:

College:

Years Completed:

Course of study:

Other:

Years Completed:

Course of study:

Professional References

Reference 1

Name:

Address:

Phone Number:

Reference 2

Name:

Address:

Phone Number:

I CERTIFY THAT ANSWERS GIVEN HERIN ARE TRUE AND COMPLETE.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION.

THIS APPLICATION FOR EMPLYMENT SHALL BE CONSIDERED ACTIVE FOR A PERIOD OF TIME NOT TO EXCEED 45 DAYS. ANY APPLICANT WISHING TO BE CONSIDERED FOR EMPLOYMENT BEYOND THIS TIME PERIOD SHOULD INQUIRE AS TO WHETHER OR NOT APPLICATIONS ARE BEING ACCEPTED AT THAT TIME.

I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN “AT WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYEMNT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHARNGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.

IF THE EVENT OF EMPLOYEMENT, I UNDERSTANT THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATIONOR INTERVIEW(S) MAY RESULT IN DISCHARGE. I UNDERSTAND, ALSO THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE EMPLOYER.

  By typing YES in this box I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

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