Application for Employment
(Please complete the entire application)

1. Employer Information: AXZONS HEALTH SYSTEM CORPORATION
70 E Sunrise Hwy, Suite # 500, Valley Stream, NY 11581 (Tel / Fax:1-866-429-9667)


It is the policy of AXZONS HEALTH SYSTEM CORPORATION to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Email address *
APPLICANT INFORMATION
Applicant Full Name: *
Maiden Name
Gender *
Date of Birth: *
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Country Of Birth: *
Age: *
Race: *
Height: *
Weight: *
Hair Color: *
Eye Color *
Social Security Number: *
Driver License Number: *
Address *
City/State/Zip *
Home Phone Number:
Mobile Phone Number: *
Job Position Applied For: *
Are you at least 18 years old:
How will you get to work *
Are you willing to work any shift, including nights and weekends: *
If you are offered employment, when can you begin work: *
Are you eligible for employment in United States without sponsorship: *
Are you a Veteran or individual with Protected Status: *
Are you able to perform the essential functions of this Job without reasonable accommodation:
Applicant's Skills: Select the skills from the list with which you have experience for more than 1 year. *
Required
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