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Application for Employment

If you are human, leave this field blank.

Select One

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

If you are hired will you be able to submit proof of the above?

Yes

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

Employment Search/Agency

College/Recruiting

Friend

Employee

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

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

Do you have a valid driver's license?

Yes

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