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:
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:
Shift Preferred:
7am to 7pm
7pm to 7am
7am to 3pm
3pm to 11pm
11pm to 7am
EDUCATION
For nursing or paraprofessional registrations, certifications or licenses you hold:
(Bring your professional licenses, registration, etc... to interview.)
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".
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: