Caregiver Job Application

Certified Nursing Assistant Application:
Full Name (including middle name)*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Social Security Number*
Cell Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
E-mail*
Are you licensed as a CNA with the Maryland Board of Nursing?*

YesNo
CNA License Number*
How did you hear about Nursing Care Experts?*
Do You Have A Full Drivers License? (Not Provisional)*

YesNo
Drivers License Number*
Drivers License State *
example: Maryland
Do You Own A Car?*

YesNo
Distance Willing To Travel?*

Education:
High School*
Name of High School Attended
Number of Years Attended
Graduated?*

YesNo
I have my GED

YesNoOther
CNA School/Program *
Name of School Attended
Month/Year CNA Program Completed*
College
Name of College/University Attended
Number of Years Attended
Graduated?

YesNoSome College
Area of Study/Degree

Skills/Qualifications:
Please list additional skills or qualifications
List any relevant skills

Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position
Salary
Start Date

MonthDayYear
May We Contact for Reference?*

YesNo
Supervisor Name
Name of Reference
Supervisor Phone
Previous Employment:
Previous Employer*
Name of Previous Employer
Position*
Salary
Reason for Leaving?*
Start Date*

MonthDayYear
End Date*

MonthDayYear
I give permission to contact this employer for a reference.*

YesNo
Supervisor Name *
Name of Reference
Supervisor Phone*
Supervisor Email
Previous Employer (or personal reference if no additional previous employers)*
Name of Previous Employer
Position*
Salary
Reason for Leaving?*
Start Date

MonthDayYear
End Date

MonthDayYear
I give permission to contact this employer for a reference.*

YesNo
Supervisor Name *
Name of Reference
Supervisor Phone*
Supervisor Email
Nursing Care Experts Inc. uses a reference-checking company, CheckR, to conduct reference checks for all candidates. During the application process, you may receive an e-mail directly from CheckR requesting you to give consent to check your references, as well as to input information regarding who to contact for references. This is a vital step in the hiring process.
Background Check Information:

Background Check Disclosure: As part of the employment process, Nursing Care Experts Inc, hereby known as "the company", may obtain a consumer report and/or investigative consumer report. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996 requires that we advise you that for the purposes of employment only, a Consumer Report may be made which may include information about your credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided in the event the Report contains information regarding your character, general reputation, personal characteristics, or mode of living. Authorization and Release: During the application process and at any time during any subsequent employment, I hereby authorize U.S. Information Search on behalf of The Company to procure a Consumer Report which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This report may include Criminal Records, Credit reports, Driving Records, Past Employment or Education Verifications, Workers Compensation Claims, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in original, fax, digital, or copy form.
Date of Birth (for Background check authorization)*
I give my permission for a Background Check as described above.*

YesNo
Resume:

Upload your resume by clicking the link below.
Resume

Upload a File

Cancelof
Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are grounds for non-hire or termination. I authorize Nursing Care Experts Inc. to verify all information on this application, including contacting current and previous employers as directed by me above.

I understand that I am applying for temporary work on a per diem basis and the Nursing Care Experts Inc. does not guarantee that work, part-time or full-time, will be available on a consistent basis.

Nursing Care Experts Inc. is an equal opportunity employer. Federal law prohibits discrimination in employment practices because of race, religion, sex, age or national origin. No question in this application is asked for the purposes of limiting or excluding any applicant's consideration for employment because of his or her race, creed, color, national origin, sex, age, disability, marital status, sexual orientation or citizenship status.

In consideration of my employment, I agree to conform to Nursing Care Experts' rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
Signature*

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