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| Candidate
Information | ||
| * Name: | ||
| * Address: | ||
| * City: | ||
| * State: | ||
| * ZIP Code: | ||
| * Social Security No.: | ||
| * Primary Telephone: | ||
| Secondary Telephone: | ||
| Email Address: | ||
Type of Position: |
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RN |
LPN | CNA | HHA | |
Type of Employment: |
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Full Time |
Part Time | Seasonal | Internship | |
Available to Work: |
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| Day |
Evening |
Night |
Weekend | |
| Additional Comments: | ||
| Location Preference: | ||
| Salary Requirements: | ||
| How did you hear about our agency? | ||
If news media: | ||
| Article Name | Article Date
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If referral: | ||
| Referring Employee's Name: | ||
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- APPLICANT'S STATEMENT - I certify that all information provided in order to apply for and secure employment with Reflection of Light Nursing Care Agency is true, complete and correct. I expressly authorize, without reservation, ROL and its representatives to obtain information from references (personal & professional), public agencies, licensing authorities and educational institutions, including but not limited to a Criminal Record Background Check and to verify accuracy of all information provided in this application. I hereby waive any and all rights and claims I may have regarding ROL or its representatives for seeking, gathering and using information in the employment process and all other persons or organizations for furnishing such information regarding me... |