RN
Chaplain
Office
Management
Marketing
Billing
Director of Nursing
Clinical Compliance
LPN
CNA
Social Work
Call Triage
Administrator
Volunteer
Other
Full Time
Part Time
As Needed
Personal Information
First NameMiddle InitialLast Name
Street Address / Apartment Number
Street Address Line 2 (optional)
CityState
Zip Code / Postal Code
Yes
No
$ per Hour per Year
On Call
Overtime
Holidays
All of the above
Skills and Experience
Education
CMA
PT, OT, ST
PTA, COTA
Dietician
Social Worker
Work Experience
Employer 1 (required)
Street Address
CityState/Province
to Still Employed here
$ Salary Hourly
Employer 2 (optional)
Employer 3 (optional)
Legal
Plead No Contest
Note that a conviction of a crime will not necessarily disqualify you for employment.
Authorization
I certify that I have read and understand all parts of this application and certify that I have truthfully and completely answered all questions. I understand that falsification of any of the information given herein or on any other employment form is grounds for immediate termination, regardless of when such falsifications may be discovered.I authorize Cura-HPC and its representatives to investigate my education, employment experience, criminal conviction records, and all other aspects of my background relevant to my proposed employment, including all statements made by me in my application for employment. I release Cura-HPC and its representatives, as well as any person to whom such inquiry is directed, from any liability arising directly or indirectly from any such investigators.Further, I understand that employment will be contingent upon successfully passing a pre-employment drug-screening test (except where prohibited). I understand my employment with Cura-HPC is for no definite length of time. I understand my employment may be terminated at any time, with or without cause, at the option of either Cura-HPC or myself. I understand that no employee or representative of Cura-HPC has any authority to make any agreement which is contrary to the foregoing. If accepted for employment, I agree to comply with all company policies and procedures and with all rules and regulations made known at the time of employment or any other time thereafter, and to perform all duties assigned to me to the best of my ability.Cura-HPC is an equal opportunity employer. All applications for employment will be considered without regard to race, color, religion, sex, national origin, disability, age (over the age of 40), or veteran status. This application will remain active for 45 days. After that time, it must be renewed by the applicant if he/she wishes to be reconsidered for employment.