APPLY ON-LINE
TESTS ON-LINE
infection control

universal precautions

age-specific, infant - adolescent

age-specific, 18 years old - adult


STUDY GUIDES
infection control/ universal precautions

age-specific, infant - adolescent

age-specific, 18 years old - adult

The application for employment is required before beginning the online tests. Please complete the application thoroughly and submit it prior to completing the tests. Tests submitted without an application will not be processed by Human Resources. (If you have trouble with the form please email or call us and let us know, thanks.)

PERSONAL INFORMATION

*First name:
Middle name:
*Last name:

ADDRESS:
Street:
City:
State:
Zip Code:
*Your Email address:
*Phone #:
Pager #:
Best time to call:
Citizenship: Citizen Refugee
Resident Alien Immigrant
Non-Resident Alien
EMPLOYMENT DESIRED
Specific type of position you are applying for:
Geographic Preferences: 1.
2.
3.
Availability(check all shifts that apply):
First
Second
Third
Part-time
Full-time
7A-7P
7P-7A




Specialties(check all that apply): ER
Med-Surg
Peds
I CU
Labor/Delivery
Tele
Psych
Geriatrics
Home Care
Other specialties:
Social Security Number:


EDUCATION
  Name Last Year Cmpl Diplomas/Degrees
High School 1 2
3 4

Nursing School		 1 2
3 4
College 1 2
3 4
Grad School 1 2
3 4

What month & year did you pass nursing boards?
CPR Certified: Yes    No   
Renewal date:

EMPLOYMENT RECORD

List all employment beginning with your most recent
employer. If working through an agency, please indicate
the specific Hospital in which you were working as well
as the name of the agency.

1. Name of Facility or Agency:
Address:
Supervisors name and title:
Dates of employment: to
Salary:
Position(s) held:
Reason for leaving:

2. Name of Facility or Agency:

Address:
Supervisors name and title:
Dates of employment: to       
Salary:
Position(s) held:
Reason for leaving:
3. Name of Facility or Agency:
Address:
Supervisors name and title:
Dates of employment: to
Salary:
Position(s) held:
Reason for leaving:
PERSONAL REFERENCES
Give the names of two persons not related to you whom you have known at least one year.

1.  Name  
Yrs acquainted:
Address:
Phone:

2.  Name:

 
Yrs acquainted:
Address:  
Phone:
In case of an emergency notify:
Name:
Address:
Phone:
Relationship:

How did you hear about Nurses as Needed?



I certify that all of the above information is correct and that any misrepresentation or falsification of fact as part of this application may be considered sufficient cause for immediate dismissal from Nurses as Needed.

*Date:
*I agree all information is true




In office pre-placement competency testing required.**

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