Madelia Health
Hospital/ER Registered Nurse - Full Time- Overnights
Madelia Health, Hartford, Connecticut, United States
Contact Information
Name (Required) First Middle Last Email (Required) Enter Email Confirm Email Address (Required) Street Address Address Line 2 City State ZIP Code Phone Number (Required) General Employment Information
Position Applied For (Required) How did you hear about this position? (Required) Desired Pay Have you ever applied for employment with us? (Required) Yes No Are you able to work full time? (Required) (Do not include religious holidays) Yes No Are you able to work over time if asked? (Required) Yes No Are You eligible for work in the U.S.? (Required) Yes No Are You 18 years Of Age Or Older? (Required) Yes No Do you posses a valid drivers license? (Required) Yes No When will you be able to start? (Required) MM slash DD slash YYYY Employer History - Most Recent
Begin With Your Most Recent Employment (1) And Continue With Past Employment Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Employer History - Past Employment 1 of 2
Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Employer History - Past Employment 2 of 2
Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Explain Any Period Between Jobs EDUCATION
Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools Full Name of School Major Subject Degree Earned Additional information about your education history: Military or Other Special Training/Skills
Military Training or Experience, Other Skills Tell us about yourself PERSONAL OR BUSINESS REFERENCES
Add 2 References (Required) Name Occupation Business Phone Number Telephone Number Title/Relationship UPLOAD RESUME
Upload Resume Max. file size: 50 MB. NOTIFICATION AND AGREEMENT
Applicant Statement
I certify that all answers given by me are true, accurate and complete, I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.
It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.
I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.
If hired, I agree to abide by company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either Madelia Health or me, I further understand that no representation, whether oral or written by any representative or agent of Madelia Health, at any time, can constitute a contract of employment. I understand that Madelia Health and its Board of Directors shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of Madelia Health has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the Chief Executive Officer, or to make any agreement contrary to the foregoing.
I hereby understand Madelia Health is a drug free workplace and all new employees are subject to a Drug/alcohol screening upon hire. It is mandatory all employees have an annual flu vaccination or be exempted in accordance with Madelia Health’s policy.
I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. Signature (Type your initials) DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
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Name (Required) First Middle Last Email (Required) Enter Email Confirm Email Address (Required) Street Address Address Line 2 City State ZIP Code Phone Number (Required) General Employment Information
Position Applied For (Required) How did you hear about this position? (Required) Desired Pay Have you ever applied for employment with us? (Required) Yes No Are you able to work full time? (Required) (Do not include religious holidays) Yes No Are you able to work over time if asked? (Required) Yes No Are You eligible for work in the U.S.? (Required) Yes No Are You 18 years Of Age Or Older? (Required) Yes No Do you posses a valid drivers license? (Required) Yes No When will you be able to start? (Required) MM slash DD slash YYYY Employer History - Most Recent
Begin With Your Most Recent Employment (1) And Continue With Past Employment Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Employer History - Past Employment 1 of 2
Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Employer History - Past Employment 2 of 2
Employer Address Street Address City State ZIP Code Employed From (mm/yyyy) Employed To (mm/yyyy) Your Title(s) Your Duties Reason for Leaving Name & Title of Supervisor Phone Number Type of Business May We Contact Employer? Yes No Explain Any Period Between Jobs EDUCATION
Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools Full Name of School Major Subject Degree Earned Additional information about your education history: Military or Other Special Training/Skills
Military Training or Experience, Other Skills Tell us about yourself PERSONAL OR BUSINESS REFERENCES
Add 2 References (Required) Name Occupation Business Phone Number Telephone Number Title/Relationship UPLOAD RESUME
Upload Resume Max. file size: 50 MB. NOTIFICATION AND AGREEMENT
Applicant Statement
I certify that all answers given by me are true, accurate and complete, I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.
It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State or Local law.
I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.
If hired, I agree to abide by company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either Madelia Health or me, I further understand that no representation, whether oral or written by any representative or agent of Madelia Health, at any time, can constitute a contract of employment. I understand that Madelia Health and its Board of Directors shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of Madelia Health has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the Chief Executive Officer, or to make any agreement contrary to the foregoing.
I hereby understand Madelia Health is a drug free workplace and all new employees are subject to a Drug/alcohol screening upon hire. It is mandatory all employees have an annual flu vaccination or be exempted in accordance with Madelia Health’s policy.
I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. Signature (Type your initials) DO NOT SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
#J-18808-Ljbffr