Job Application: LPN- WRHC-North FT


The documents accessed from the links below must be read and understood prior to submitting an application.


Standards Of Performance Expectations

Statement Of Understanding And Release



Title: LPN- WRHC-North FT

Fields marked with an asterisk (*) must be filled out before submitting.

Contact Details

First Name
Last Name
Email Address
Address
City
State
Zip
Telephone
Cell phone

Qualifications

Have you ever been employed with Franklin Medical Center? Yes
No
If yes, please list department and dates:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship/immigration status is required upon employment.) Yes
No
Date available to start
Minimum salary requirement
Indicate type of employment Full Time
Part Time
PRN
Indicate days available to work Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Indicate shifts available to work Days
Nights
Position desired
If other was selected please explain

Current Employment

Company Name
Job Title
Company Address (Street,City,State,Zip)
Telephone
Name of Supervisor/Title
Employment Dates
Reason for Leaving
Current Salary
Job Duties

Previous Employment

Company Name
Job Title
Company Address (Street,City,State,Zip)
Telephone
Name of Supervisor/Title
Employment Dates
Reason for Leaving
Beginning Salary
Ending Salary
Job Duties
 
Company Name
Job Title
Company Address(Street,City,State,Zip)
Telephone
Name of Supervisor/Title
Employment Dates
Reason for Leaving
Beginning Salary
Ending Salary
Job Duties

Education

Do you have a high school diploma or GED? Yes
No
Highest educaction level achieved?
Name & Location of School
# of hours completed
GPA
Degree/Major
Date Degree Obtained

Skills & Certifications

License/Certification (include License #, Issuer, Issue and Expiration Dates)
 
Have you ever been convicted of a felony? Yes
No
If yes, please explain, and give dates:
Have you ever been involuntarily discharged from a job? Yes
No
If yes, please explain, and give dates:
 
List any experiences, skill or qualifications which you feel uniquely qualify you for work with our organization:
List any professional organizations of which you are a member:

References

Please list three personal/professional references(include contact information)
 
* I have read and understood the STANDARDS OF PERFORMANCE EXPECTATIONS and the STATEMENT OF UNDERSTANDING AND RELEASE.