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Application for Employment
If you are human, leave this field blank.
Select One
Full Time
Part Time
Temporary
Per Diem
Which positions are you applying for?
Certified Nursing Assistant (CNA)
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)
Your Info
Last Name
First Name
Middle
Address
City
State
Zip
Home Telephone
Message Telephone
Are you legally authorized to work in the United States?
Yes
No
If you are hired will you be able to submit proof of the above?
Yes
No
Emergency Contact Name
Relationship to you
Phone Number
Please list any relatives employed at Sweet Brook
(List name, relationship to you, location & position.)
Questionnaire
How did you become aware of the position(s) for which you are applying?
Walk-in
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Employment Search/Agency
College/Recruiting
Friend
Employee
Other
Other
Name of Referral Source
What shifts can you work?
On-Call Basis
1st Shift
2nd Shift
3rd Shift
Do you realize that it may be necessary to work on weekends, holidays, or rotation shifts?
Yes
No
What days are you available to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Holidays
What hours are you available to work?
What are the total number of hours you are available to work per week?
Are you on layoff or subject to recall?
Yes
No
Do you have a valid driver's license?
Yes
No