Temp CSN Application Form

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address*

example@example.com

Phone Number*

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? (If needed, describe below in the space provided).*

YesNo

If you answered "No" in the question above, please describe the situation.

Please be brief, but specific.

What Level of Christian Science nurse are you currently?*

Select Level 1, 2, 3, or 4.

Are you currently Journal-listed as a Christian Science nurse?*

YesNo

If you are currently a Journal-listed Christian Science nurse, please list the date of the listing.*

Ex: May 2021

How did you hear about us?*

Available Start Date*

Date

Which Christian Science nurses' training program did you take most recently?*

Type the name of the program

Are you a member of good standing in The Mother Church?*

YesNo

What year did you become a member of The Mother Church?*

Example: 1996

What is your Mother Church membership number?*

Have you been class-taught by an authorized Christian Science Teacher currently listed in The Christian Science Journal?*

YesNo

What is the name of your Christian Science Teacher?*

Please type his/her first and last names.

Are you currently an active member of a branch Church of Christ, Scientist, or Christian Science Society?*

YesNo

List the name and location of the church where you are currently an active member.*

Ex: Fifth Church of Christ, Scientist, Dallas, Texas

When did you join this branch church as a member?*

Do you study the Bible Lesson on a daily basis?*

YesNo

Do you subscribe to the Christian Science periodicals?*

YesNo

Do you rely solely on Christian Science for healing?*

YesNo

Have you had any medical diagnosis or treatment in the past three years?*

YesNo

Are you free from use of liquor, tobacco, drugs, and medication?*

YesNo

Are you able to perform the essential functions of the job for which you are applying? Essential functions may include and are not limited to: walking and standing on your feet for the 8-hour shift (other than 40-min. break), flexibility (squatting, reaching), strength and the ability to lift and support weight (mechanical lifters & multi-mover sliding sheets available for patient transfers). If you do not feel able to perform these functions, please describe below in the space provided.*

YesNo

If you answered "No" in the question above, please describe the functions that cannot be performed.

Please be brief, but specific.

If your application is accepted at The Leaves, are you willing to work all three shifts (not consecutively), as well as weekends and/or holidays? Shift schedule: Morning 7am-3pm, Afternoon 3pm-11pm, Night 11pm-7am. If no, please explain.*

Please be brief, but specific.

What is your current or most recent job? *

Employment Start Date*

Date

Employment End Date*

Date

What job did you have before that?

Employment Start Date*

Date

Employment End Date*

Date

Upload Your Resume

Cover Letter

Have you worked for / as a medical professional in the last five years?*

YesNo

If yes to the above question, please describe in what capacity you worked.

Type the job title / position you held

List languages you speak/read/write fluently:*

Ex: Spanish, French, English

Reference 1*

Reference 2*

If my Application is accepted, I agree to comply with the Christian Science nursing and the Christian Science nurses’ training standards, policies, and procedures as outlined by The Leaves. The Leaves will not fail or refuse to hire, discharge or discriminate in compensation and terms, conditions and privileges of employment based on race, color, disability, religion, sex, national origin or age (40 and older). The Leaves also won't limit, segregate or classify employees and applicants in ways that deprive or tend to deprive them of employment opportunities or adversely affect their employment status based on protected status categories. *The Leaves can hire and employ based on bona fide occupational qualifications, except that race and color are not considered BFOQs. It is expected that all applicants be able to perform the essential functions of the position for which they apply. Reasonable accommodation will be made for qualified individuals with disabilities to the extent required by law. It is unlawful in The State of Texas to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Hiring is contingent upon our receipt of appropriate documentation of your eligibility for employment in the United States. The Leaves, Inc. is an “at-will” employer. If your application is accepted, should your needs or the needs of The Leaves change at any time for any reason, either party may end the employment relationship. This also means that this application for employment does not constitute a contractual arrangement; and it is not active for any defined period of time. I understand that if my Application is accepted, I will have the status of temporary employee of The Leaves and will receive a salary, but my employee status will not make me eligible for employee benefits. After I have successfully completed a probationary period as stated in any contractual agreements made at the time, and accompanying performance reviews, I may apply for benefit-eligible employee status. By clicking submit below, you affirm that the information provided on this application is true and that you understand the terms of the application agreement, including those given below.

Temp Christian Science Nursing Application

Employment History

More Background

Language

References