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Employment Application

Application Information

Date Available to Start
Month
Day
Year
Are you legally eligible to work in the U.S?
Yes
No
Have you worked in healthcare before?
Yes
No
CPR Certified?
Yes
No
  1. Skilled Checklist

Check all that apply:

Clinical Skills

Check Below

Administrative Skills

Check Below

Special Population Experience

Check Below
  1. Confidentiality Agreement

I acknowledge that I may have access to confidential information, including patient records and company data. I agree to keep all such information private and not to disclose it to anyone not authorized to receive it.

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Date:
Month
Day
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  1. Employment Handbook Acknowledgement

I acknowledge receipt of the employee handbook and understand that it is my responsibility to read and comply with the policies and procedures contained within it.

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Date:
Month
Day
Year
  1. Dress Code Acknowledgement

I acknowledge that I have received and understand the company's dress code policy. I agree to comply with the dress code at al times while on duty.

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Date:
Month
Day
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  1. Social Media Policy Acknowledgement

I understand that I must use social media responsibly and in a manner that reflects positively on the organization. I agree not to post patient-related information or company-sensitive content.

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Date:
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  1. Job Description Acknowledgement

I acknowledge that I have received and reviewed the job description for my role. I understand the duties and responsibilities and affirm that I am capable of performing them with or without reasonable accommodation.

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Date:
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