Employment Application Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Certifications CNA NAR LPN RN Other Credentials Nurse Delegation Nurse Delegation with Focus on Diabetes Mental Health Dementia CPR/First Aid Orientation and Safety Washington State Food Worker Card Other Other CredentialsPlease describe yourself*Job QuestionsDo you have a reliable way to get to work on time?* Yes No Have you ever been convicted of a felony?* Yes No Are you over 18 years old?* Yes No Do you have experience using Microsoft Office (Word, Excel) or similar?* Yes No Can you speak, read and write the English language proficiently?* Yes No Are you legally authorized to work in the United States?* Yes No Can you lift up to 50 lbs. without assistance?* Yes No What do you think would be a good reason to be absent from work?* What would be a reason for you to quit without notice?* How do you handle people who are hard to get along with?* What is your level of education?* What was your last job?*What were your duties at your last job?*Please list two references with contact information.Reference 1*Reference 2*Job Expectations/Availability*Are there any medical condition that which may limit your ability to perform the job applied for?* Yes No Please describe job hindering medical conditions.*File UploadsPlease use this to upload all certificates along with your CPR and First Aid card. Drop files here or Select files Max. file size: 50 MB. Please check the box belowPhoneThis field is for validation purposes and should be left unchanged. Hours of Operation Daily: 8:00 AM - 5:00 PM About SERVICES GET IN TOUCH
