Employement Application
Please fill out fully.
Full Name
*
Given Name
Middle Name
Last Name
Suffix (eg Jr., III)
Gender
*
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Information
*
Religion
*
Background
Educational & Professional
Educational Background
Employment Experience
*
Exams Taken / Licenses
*
Qualifications
Certificates & Qualifications
Do you have a valid nursing license? If yes, please provide details.
*
Upload your license.
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Do you have any specific certifications related to caregiving or nursing (CPR, First Aid, etc.)?
*
If so, please upload them here.
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Are you familiar with common medical procedures and equipment used in caregiving and nursing?
*
Are you comfortable working with patients of different age groups (e.g., infants, adults, elderly)?
Availability
Are you available to work full-time or part-time?
Please Select
Full-Time
Part-Time
Open
Kindly take a self portrait on a plain background.
Are you open to working weekends, evenings, or overnight shifts?
Please Select
Weekends
Evenings
Overnight
Open
Are you available for on-call duties or emergency situations?
Please Select
Yes
No
Patient Care
Describe your approach to providing compassionate and patient-centered care.
How do you ensure the safety and well-being of your patients?
Can you provide an example of a time when you worked collaboratively with a healthcare team?
Have you worked with patients who have specific medical conditions or special needs?
How do you effectively communicate with patients and their family?
How do you handle challenging or difficult situations with patients or their families?
Personal Attributes
What qualities do you possess that make you a good caregiver?
How do you maintain professionalism and confidentiality in a caregiving role?
Are you comfortable working independently or under supervision?
Additional Information
Is there any additional information or qualifications you would like to share?
Are you legally authorized to work in the country where the position is located?
Criminal History
Have you ever been convicted of a crime (excluding minor traffic violations)? If yes, please provide details, including the nature of the offense, date, and jurisdiction.
Please upload your Resume & Cover letter.
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Please UPLOAD all CEU's including HIPPA, Zero Tolerance, etc.
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Please ensure you have your HIPPA Training below...
TRAIN.ORG INSTRUCTIONS-1.Go to www.Train.org. 2. Create and fill out profile (person information) 3. Join Group Location (Florida) b. Northeast Agency 4.Organization-Grade A Nursing Services LLC 5.Agency- Northeast 6.Title- RN, LPN, CNA, HHA 7. ONCE YOU HAVE AN ACCOUNT PLEASE DO THE FOLLOWING COURSES. ( Direct core competencies; done in order- Modules 1-55.) (Zero Tolerance Modules 1-46) (HIPAA basics) (Psychological first aid) (Bloodborne Pathogen training) (All APD provider requirements) 8. Once courses are completed upload them below. If you have issues please contact us via Facebook messages.
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