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Apply Now - CNAs and Allied Health Professionals

Pre-Employee Agreement

Part of the hiring process includes testing for controlled or illegal substances. If you wish to complete the application process, you must participate in such testing and consent to such testing by signing this form.

Yes

I consent to the testing of specimens provided by me in order to determine the presence of controlled substances, and I recognize that the analysis results of such specimens will be used to determine suitability of employment.*

Your name (Digital signing of document)*

Date*

Thank you!

We have received your submission.

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Application

Name

Address

Address Line 1*

Address Line 2

City*

State*

Zip*

3 References (1 Must Be A Professional Reference)*

Phone Number*

Email*

Date of Birth*

Are you a Citizen?*

Yes

What State Issued Your Driver's License?*

Past Work History*

Past Education History*

Are you looking for*

Temp to HirePer DiemAdministrative Role

Which are you certified?*

LPN

CNA

PCA

Medication Aide

Medication Tech

Certified Medical Assistant

Nurse Practitioner

Physician Assistant

Other

What attracted you to healthcare and what do you find rewarding about it?*

How do you feel about creating your own schedule and rotating to different facilities? How far are you willing to travel?*

Why are you leaving your last job?*

What are you looking for in your next job?*

Are you searching for a part-time or full-time position? Long-term or short-term?*

What is your minimum salary requirement? Is it negotiable?*

How soon could you begin to work?*

Why do you want to work here?*

AS a healthcare professional have you worked or are you committed to take care of Covid patients?*

Our partner facilities ensure safety protocols being implemented to prevent COVID-19 infections at work however we DO NOT guarantee that all facilities will remain covid free. At this time we service both COVID AND NONCOVID FACILITIES.

May we Check References?*

YesNo

Have you submitted your resume active TB test and CPR License to the appropriate email listed above?*

YesNo

Where did you hear about us?

FacebookInstagramWord of Mouth / ReferralSchool boards/career centersJob fairSearch engineLinkedInIndeed

Thank you!

We have received your submission.

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Bad respond

For CNA's and all Allied Health Professionals

Please send in your updated resume, active TB test, Covid Vaccination, and CPR License to:asrvnthr@gmail.comPlease use your name as the subject line.*Required prior to submission

A Servant's Heart Staffing Service, LLC

Home          Clients           Careers Apply Now - Nurses          Apply Now- CNAs, Med Tech, & Med Aide Contact

PO Box 38212 Greensboro NC 27408

 Office: (805) 991-7506 |  Fax: (805) 991-7506

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