Maddie's Place-RN Application

Maddie's Place-RN Application

Provide Direct Patient Care to Maddie’s Place Infants while following the Mission and Vision of the organization. Medical and non-medical/holistic care is provided directly to infant patients, 0-12 months. RN's provide care and patient management within a team approach, while supervising Infant Care Specialists and Volunteer Cuddlers.
Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address

street address

Street Address Line 2

citystate

ZIP
Email
example@example.com
Phone Number
Please enter a valid phone number.
Phone Number Type

HomeCell
What is your preferred method of communication?

Phone CallEmailText
Additional names used (maiden, prev. married, etc)
Emergency Contact
Name

First NameLast Name
Phone
Relationship to you
Education and Work Experience
What is the highest level of education you have completed?

High School/GEDSome CollegeAssociate DegreeBachelor's DegreeMaster's DegreePh.D.
Current Employment Status

Employed Full-TimeEmployed Part-TimeRetiredUnemployedStudent
If Employed, Where?
Please list any relevant certifications: basic first aid, CPR, etc
Please list any work, life, or volunteer experiences you have that may benefit our patients and/or staff.
How did you hear about Maddie's Place?
Why are you interested in working with us?
Please explain any health conditions you would like to us to be aware of.
Describe any type of assistance that will be needed,
Have you ever been convicted of or plead guilty to any criminal offense other than a minor traffic violation?

YesNo
If "Yes," please explain:
Position Requirements
All RN’s  must meet the following requirements:
- Have an Associate RN degree or BSN
- Complete all pieces of the Maddie's Place application process including a state background check, ID verification and health screening (we can help with these).
- Complete all training required for this position, as dictated by the WA State Dept of Health and Maddie’s Place.
- Have a non - judgmental, supportive attitude towards moms, dads and caregivers.
- Be able to walk and carry unassisted.
- Be able to bend down and lift 20 pounds
- Assist in any areas of the nursery as needed
- Abide by dress code (Clothing and footwear must be professional. Scrub pants optional, jackets provided.)
- Do not wear perfume, scented lotions, and/or aftershave.
- Be able to verify immunity to the following with immunization records or serum titers:
  Chickenpox (Varicella), MMR ,Tdap, HepB (may show proof of vaccination, immunity or immunization refusal)
  Show a negative TB test.
  Be willing to accept an annual flu shot.
  Understand that COVID guidelines change rapidly and we must meet applicable requirements as a Healthcare Entity in the state of Washington.
Employee Agreement
I certify that the information provided in this application is complete and accurate to the best of my knowledge. If hired, I will abide by all Maddie's Place policies and procedures, including holding patient information in strict confidence; as well as the requirements listed above. Failure to comply with these requirements may result in immediate dismissal. By my signature below, I certify that I have carefully read, understand and agree to the conditions of the agreement.
Date

MonthDayYear
Date
Signature

Clear
Please provide a scan of valid Photo ID

If you are unable to upload your file, please email separately to jan.klein@maddiesplace.org
Cancelof
Interview Question
Please respond to the interview question below. We will discuss your response together during your interview.
How does a woman who took recreational drugs during her pregnancy deserve to be treated or helped?
Thank you for your interest in working at Maddie's Place! We will contact you via email as soon as your application has been reviewed.
Should be Empty:

Maddie's Place-RN Application

Emergency Contact

Education and Work Experience

Position Requirements

Employee Agreement

Interview Question