If YES, please provide an explanation below.
If YES, please specify additional educations.
SELECT THE SKILLS THAT YOU HAVE.
YOU NEED TO HAVE WORKED AT LEAST 1 FULL YEAR IN THE SELECTED POSITION.
The checklist is meant to serve as general guideline for our client facilities as to the level of your skills within your speciality. Please use the scale below to describe your experience/expertise in each area listed below.
You will need to choose 2 employers from your work history as references.
References need to equal up to 1 year of employment.
Do not list staffing agencies only hospitals/facilities
1) Are you at least 18 years or older? *
2) Any gap in Employment for more that 30 days? *
5) If hired, can you present evidence of your eligibility to work in United States? *
(Initial each numbered item as read)
1) I certfify that all the informaiton I have given on this application is true and complete and that I have not knowlingly withheld any information that might adversely affect my chances for employment. I understand that failure to provide complete information or any misrepresentation in the information I provide whether on this for or otherwise may lead to refusal to hire me to termination of employment. *
2) I authorize inquiry into any suitability for the position for which I am being considerred and I hereby give my consent to present and past employers to release the informaation necessary to verify my work history and hereby release my present and past employers from all liability for any demages whatsoever arising for th release of any and all information regarding my employment. *
3) I understand that there is no offter of an employment contract or guarantee of lenght of employment and that I should be hired my employment and compensation can be terminated, with or without notification or cause, at any time, at the option of either the firm or myself. I understand that no employee or other representative of the firm is authorized to make any other representation to employees regarding the term of my employment. And I confirm that no other representation has been made to me. *
4) In compliance with Federal Law, all persons hired will be required to verify identity and eligibility to work in United States and to complete the required employment eligibility verfication document form upon hire. *
5) I authorize HealthCare Pros to obtain consumer investigation reports from consumer reporting agencies for use in decidingg whether or not to offer me employment. I understand that such reports may include information concerning my credit worthness, credit standing, credit capacity, character general reputation, personal characteristics or mode of living. I understand that if I am denied employment based upon information contained in any credit report, I will be provided with the name, address, and telephone number of the consumer reporting agency, a copy of the report and an explanation of my rights concering it. *
6) I understant that HealthCare Pros is committed to maintaining a drug and alcohol free work plan. Accordingly I may be subject to a pre-employment blood test. Urinalysis or other drug/alcohol screening I further understant that if employed, I may be subject to such a drugh and alcohol screening. I HealthCare Pros has reasonable suspiction to believe that I am under the the influence of a drug/alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shell result in a refusal to hire or if already employed termination. *
7) I have placed my signature in the space provided below only after I have completed the entire form to the best of my ability and have carefully read and foregoing (7) statements. *
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