We invite you to apply for Des Arc Nursing & Rehabilitation Center by completing the employment application below. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastEmail *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *How did you hear about us? *WebsiteGoogle SearchWord of MouthSocial MediaHospital ReferralOtherPosition DesiredPosition Applying For *Registered Nurse (RN)Licensed Practical Nurse (LPN)Medication Assistant Certified (MA-C)Certified Nursing Assistant (CNA)DietaryHousekeepingWhen can you start? *Can you work any shift? *YesNoAre you under 18 years of age? *YesNoIf yes, do you have a work permit?YesNoHave you ever been convicted of a crime? *YesNoIf yes, please explain the offense, the date and the place.Conviction of a criminal offense will not necessarily prevent your employment.Have you ever applied to this company before? *YesNoIf yes, who was your supervisor?If yes, when?Can you perform the functions of the job for which you are applying with or without reasonable accomodations? *YesNoIf no, please explain.EducationPlease select the highest level achieved. *High SchoolCollegeGraduate DegreeOtherProfessional License or CertificateType of LicenseState Issued InExpiration DateHas your license ever been suspended?YesNoIf yes, please explain when and why.Employment HistoryPlease list most recent employer *Date Started *Status *Currently work hereNo longer work hereJob Title *Hourly/Salary *Work/duties performed *Please list previous employerDate StartedStatusCurrently work hereNo longer work hereJob TitleHourly/SalaryWork/duties performedPlease list previous employerDate StartedStatusCurrently work hereNo longer work hereJob TitleHourly/SalaryWork/duties performedReferencesPlease provide three work-related references not related to you. If work-related references are not available, teachers, clergy, or other personal references may also be submitted.Reference 1: Name *Reference 1: Relationship *Reference 1: Company Name (if applicable)Reference 1: Email *Reference 1: Phone *Reference 1: Years Acquainted *Reference 1: Address *Reference 2: NameReference 2: RelationshipReference 2: Company Name (if applicable)Reference 2: EmailReference 2: PhoneReference 2: Years AcquaintedReference 2: AddressReference 3: NameReference 3: RelationshipReference 3: Company Name (if applicable)Reference 3: EmailReference 3: PhoneReference 3: Years AcquaintedReference 3: AddressEmployment Understanding and AcknowledgementI understand that all Company policies, procedures and guides, including any employee handbook, are not intended to be and shall not create a contract of employment with the Company for any specific duration or for any other purpose. If employed, I agree to conform to the rules, policies and regulations of the Company. I certify that the information I have provided on this employment application or in conjunction with this application is correct, complete and true to the best of my knowledge. I understand that any false or misleading statement made by me in this application or in connection with my seeking employment or the failure to disclose pertinent information in this application or in conjunction with my seeking employment may result in my disqualification from consideration of employment or may be grounds for immediate termination of employment.Do you understand and agree? *I AgreeSign Here *Clear SignatureAuthorization for Previous Employer to Release Information *Clear SignatureI, hereby authorize my prior employers to release any and all information relating to my employment with them to Team Staffing. I further release and hold harmless both my previous employer and Team Staffing from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employer will be held in strictest confidence, that it will be viewed only by those involved in the hiring decision, or subpoenaed by a court of law, and that neither I nor anyone else not so involved will have the right to see the information obtained.Submit
