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Employment Application
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* Indicates required question
Position you are applying for:
*
Choose
RN
LPN
CNA
Nurse Aide
Companion Aide
First & Last Name
*
Your answer
Street Address
*
Your answer
City & Zip Code
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Email Address
*
Your answer
Do you have the following (you MUST have and maintain items below for employment):
*
Valid Michigan Driver's License
Current Auto Insurance
Clear Background Check
Reliable vehicle (must have own transportation)
Required
Availability - check all that apply
*
Days
Afternoons
Midnight
Weekdays
Weekends (Priority given to W/E availability)
4-hr shifts
8-hr shifts
12-hr shifts
House call visit
Required
How many hours per week would you like?
*
Your answer
Do you intend to work another job?
*
Choose
Yes
No
Maybe
Available days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Referred by
*
Choose
Friend/Acquaintance
Indeed
Nursing Unlimited Website
Drove By / Sign
Facebook
Care.com
Other
Name of person who referred you:
Your answer
Date available to start
*
MM
/
DD
/
YYYY
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