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RN
Full Time, Part Time
The Nursing Home
Posted 8 months ago
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APPLICANT INFORMATION
First Name
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Middle Initial
Last Name
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Maiden Name
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Address (Street, PO Box)
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City, State, Zip
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Best Phone Number to Contact You
*
E-Mail Address
Are you at least 18 years of age or older?
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Yes
No
Are you legally able to work in the U.S.?
*
Yes
No
Have you been convicted of a felony within the last seven (7) years?
*
Yes
No
If yes, please explain
Are you a licensed RN in the state of Nebraska?
*
Yes
No
What is your RN license number?
JOB INFORMATION
What position(s) are you applying for?
*
What shift(s) are you willing to work?
*
Day
Evening
Night
Weekend
Holidays
Are you willing to work overtime as required?
*
Yes
No
Are you willing to work on the weekends?
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Yes
No
What type of hours are you looking for?
*
Full Time
Part Time
PRN
Pool
Temporary
Seasonal
Internship
When can you start work?
*
Have you ever applied to work here before?
*
Yes
No
Have you ever worked for Blue Valley Lutheran Homes?
*
Yes
No
If so, when, who was your supervisor and reason for leaving?
EDUCATION
Last grade completed (pick one)
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Grade School
High School - 9
High School - 10
High School - 11
High School - 12
Some College
Associates Degree
Bachelor Degree
Masters Degree
PhD
Name of high school
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Name of college
Degree(s) obtained
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Name of vocational/trade school
REFERENCES
Professional Reference 1 - Name & Title/Position
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Professional Reference 1 - Address (including city, state, zip)
*
Professional Reference 1 - Email and/or Phone Number
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Professional Reference 1 - Years Known
*
Professional Reference 2 - Name & Title/Position
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Professional Reference 2 - Address (including city, state, zip)
*
Professional Reference 2 - Email and/or Phone
*
Professional Reference 2 - Years Known
APPLICANT STATEMENTS
By checking this box, you confirm the above information is complete and true to the best of your knowledge.
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Yes I confirm
By checking this box, you authorize Blue Valley Lutheran Homes to contact any or all of the listed references for full information
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By checking this box, I understand that Blue Valley Lutheran Homes is an Equal Opportunity Employer
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