We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, disability, marital status, or any other legally protected status.

Please Fill all Fields, Then When You Finish, Click Submit.

Applicants Statement: I certify that answers given herein are true and complete I have given a comprehensive record of my work history for the last 5 years, and/or I have explained all breaks in employment history I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment beyond this time period shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time I hereby understand and acknowledge that, unless otherwise definedlaw,with this byapplicableemploymentrelationshiporganizationis any resignat any time and the employer may discharge employee at anytime with or without cause. It is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment I understand that false or misleading information given in my application or interviews(s) may result in discharge. I understand also, that I Am required to abide by all rules and regulations of the employer.

Professional Reference Verification Form I authorize the release of the following information regarding my personal character:

DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES

Triumph Staffing, LLC may request from a consumer reporting agency and for employment-related purposes, a Background Report containing background information about you in connection with your employment.

HireRight, LLC will prepare or assemble the background reports for Triumph Staffing,LLC

The Background Report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include: Criminal History Litigation History; Motor vehicle records, Social Security Number Verification, Address, Credit History, Verification of Education, Employment and Earning History, Professional Licensing, Credential and Certification Checks; Drug/Alcohol Testing Results and History;Military Service;and other information

I authorize TRIUMPH STAFFING AGENCY permission to perform a complete CRIMINAL BACKGROUND CHECK & DMV (DEPARTMENT OF MORTOR VEHICLE) ran on file in the HUMAN RESOURCE DEPARTMENT and all other reports described above about me as of this application's date.

In order to provide suitable assignments for you, the following checklist is a method of assessing your professional profiency as a CNA. Please Check All Fields That You Have Experience in.

22 Skills

In order to provide suitable assignments for you, the following checklist is a method of assessing your professional profiency as a Nurse. Please rate your skill level as accurately as possible by placing a Rating 1-5 in each approiate field.

                     1  = No Experience; Theory/Observed Only

                     2  = Intermittent Experience

                     3  = Moderate Experience >5 Times Per Year/Needs Review

                     4  = Competent; Performs On A Daily or Weekly Basis/Proficient

150 Skills