Employment Form

Prefer the old fashioned application?
Download the PDF to fill it out and turn it in!

Application for Employment

General Data

City
State/Province
Zip/Postal
Country

Personal Data

Professional & Technical Applicants Only

If you're not applying for a position in a technical or professional field where licensing or other specific institutional information would apply, please skip this section.

Skills

Military Experience in Armed Forces of the U.S. or in a State Militia (U.S.)

Education

Professional References

Work Experience

Begin with most recent job. Please fully account for all time, including periods of unemployment and any prior employment by this company. Use additional pages if necessary.

Work Experience

Work Experience

Work Experience

Work Experience

Signature

I HEREBY CERTIFY THAT THE INFORMTAION CONTAINED IN THIS APPLICATION FORM IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND AGREE TO HAVE ANY OF THE STATEMENTS CHECKED BY ACUTE NURSING CARE UNLESS I HAVE INDICATED TO THE CONTRARY. I AUTHORIZE THE REFERENCES LISTED ABOVE TO PROVIDE ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENTAND ANY PERTINENT INFORMATION THAT THEY MAY HAVE. FURTHER, I RELEASE ALL PARTIES AND PERSONS FROM ANY AND ALL LIABILITY FOR ANY DAMAGES THAT MAY RESULT FROM FURNISHINGS SUCH INFORMATION TO ACUTE NURSING CARE AS WELL AS FROM THE USE OF DISCLOSURE OF SUCH INFORMATION BY ACUTE NURSING CARE OR ANY OF ITS AGENTS, EMPLOYEES OR REPRESENTATIVES. I UNDERSTAND THAT ANY MISREPRESENTATION, FALSIFICATION, OR MATERIAL OMISSION OF INFORMATION ON THIS APPLICATION MAY RESULT IN MY FAILURE TO RECEIVE AN OFFER OR IF I AM HIRED IN MY DISMISSAL FROM EMPLOYMENT. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE RULES AND STANDARDS OF THE COMPANY AND AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED AT WILL, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, EITHER AT MY OPTION OR AT THE OPTION OF ACUTE NURSING CARE. I UNDERSTAND THAT NO EMPLOYEE OR RESPRESENTATIVE OF THE COMPANY OTHER THAN THE PRESIDENT OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYEMNT FOR ANY SPECIFIED PERIOD OF TIME OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING. FURTHER, THE PRESIDENT OF THE COMPANY MAY NOT ALTER THE AT-WILL NATURE OF THE EMPLOYMENT RELATIONSHIPS UNLESS HE/SHE DOES SO SPECIFICALLY IN WRITING. I ALSO UNDERSTAND THAT ALL OFFERS OF EMPLOYMENT ARE CONDITIONED ON THE PROVISION OF SATISFACTORY PROOF OF AN APPLICANT’S IDENTITY AND LEGAL AUTHORITY TO WORK IN THE U.S.