DOC'S NURSING JOBS, INC

Application for Employment
Doc's Nursing Jobs, Inc is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, marital status, disability, or any other basis prohibited by law.


Personal Information:

Name (Last, First, Middle Initial):
*
Other names employed under?:
*Address(Number, Street, City, State, Zip Code):
*Home Phone:

Other Phone:

*Social Security #:

*E-Mail Address:

Are you a citizen of the United States?:
Yes No
(Appropriate documentation will be required upon offer and acceptance of employment.)

If not, have you received employment authorization from the United States Immigration and Naturalization Service to work in the United States?:
Yes No

Have you ever been convicted of a felony?:
Yes No

How Did You Hear About Doc's?:

Referred by:

Have you ever been previously interviewed by a DOC'S entity?:
Yes No

If yes, when and where?

Have you previously been employed by a DOC'S entity?:
Yes No

If yes, when and where?

Position(s) Applying For:

Date available for work:

Shift Preferred:
7am to 7pm 7pm to 7am 7am to 3pm 3pm to 11pm 11pm to 7am


EDUCATION

High School:

School:

Address & Telephone:

Did You Graduate?:
Yes No

High School Degree:
(If no, did you recieve a GED?)

College:

School:

Address & Telephone:

Did You Graduate?:
Yes No

College Degree:

Graduate Study:

School:

Address & Telephone:

Did You Graduate?:
Yes No

Graduate School Degree:

Technical or Professional School:

School:

Address & Telephone:

Did You Graduate?:
Yes No

Technical or Proffesional School Degree:


For nursing or paraprofessional registrations, certifications or licenses you hold:
(Bring your professional licenses, registration, etc... to interview.)

Type:

Expiration Date:

Number:

State:

Type:

Expiration Date:

Number:

State:

Typing Skills

Can you type?:
Yes No

Words per minute:

Computer Skills

Computer Experience?
Yes No

Program(s):


Employment History
Start with your present or most recent job including military service assignments. Account for all periods of unemploymen, including time in school or training. If you have worked for more than three employers, please use the text box marked "Additional Employers".

Name of present employer: Telephone: Complete Address:

From Mon/Yr:
To Mon/Yr:
Starting Salary:
$
Final Salary:
$

Supervisor:
Department:
Reason For Leaving:

Position or Title:

Employment Status:
Full-Time Part-Time PRN as needed

Responsibilities:


Name of present employer: Telephone: Complete Address:

From Mon/Yr:
To Mon/Yr:
Starting Salary:
$
Final Salary:
$

Supervisor:
Department:
Reason For Leaving:

Position or Title:

Employment Status:
Full-Time Part-Time PRN as needed

Responsibilities:


Name of present employer: Telephone: Complete Address:

From Mon/Yr:
To Mon/Yr:
Starting Salary:
$
Final Salary:
$

Supervisor:
Department:
Reason For Leaving:

Position or Title:

Employment Status:
Full-Time Part-Time PRN as needed

Responsibilities:


Additional Employers:


Certification and Acknowledgement

I hereby certify this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.   I understand that false or misleading information given in this application and/or in my interview(s) will void this application or subject me to discharge at any time If I am employed.

I expresslyacknowledge and understand that in the abscence of a written contract to the contrary, my status, If I am hired, will be that of an employee and will have no contractual right, express or implied, to remain in the facility's employ.   In this connection, I expressly acknowledge further that neither anything said to me during the facility's application and interview process or during employment nor any provision in the facility's employee handbook or personnel manual constitutes the terms of an implied employment agreement.   In consideration of any employment offered.   I specifically agree that my employment may be terminated, with or without cause or notice, any time at the option of either the facility or myself.   I understand that no unauthorized represantative may enter into any agreement for employment or make any agreement contrary to the foregoing.

I understand and agree to the terms listed above. Date:

I expressly agree that my prior employer(s) and current employer may be contacted for the purpose of investigating my background, and I understand that information regarding my prior and current employment(s) may be used by AHC in considering this application. It also hereby permits my present and prior employer(s) to disclose to AHC information in their possession or subject in their control, including information contained in my personnel files.   In this regard, I expressly release AHC from any and all liability of whatever kind and nature which, at any time, may result from obtaining and making an employment decision based upon the requested information.

I expressly acknowledge and agree that employment with AHC if offered, is contingent upon my completeion, with favorable results, of a pre-employment physical examination including a drug screening test.

I understand and agree to the terms listed above. Date:

I understand that UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR, OR SIMILIAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.

I understand and agree to the terms listed above. Date:

doc@medicaltransportandnursing.com


You are visitor #

Click for Washington, District of Columbia Forecast
Current Weather For Washington, DC!

Director's published medical papers
Click and type Oriji and return