Job Application

Title: Registered Nurse

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

Personal Details

First Name *
Last Name *
Address *
City
Zip

Contact Details

Email Address *
Telephone *
Cell phone *
Valid Drivers License? * Yes
No
How did you hear about us?

Education/ Skills

High School Diploma/GED * Yes
No
College Degree * Yes
No
Degree Type(s)
Are you currently licensed or certified? * Yes
No
Please list any other licenses or certifications
Do you have a current CPR certification? * Yes
No
Special Skills/Experience Caring for Elders * Yes
No
Please list any skills you have that are appropriate for the position you are applying for
State fully why you believe you are qualified for this position
Interests/ Accomplishments: You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the positon(s) you are seeking. Names or organizations designating religion, race, etc. need not to be mentioned.
Are you able to lift at least 45 lbs? * Yes
No
Are you able to climb stairs, bend and stand for long periods of time? Yes
No

Military

Have you ever served in the Armed Forces? Yes
No
If so, specialty
Are you currently in the National Guard? Yes
No
If so, specialty

Work History (previous 3 yrs)

Do you have a resume? If so, please upload to take the place of the following fields
Previous Employer 1
Supervisor
Date started
Date left
Job Title/ Duties
Pay
Company Phone Number
May we contact this employer? Yes
No
Reason for leaving?
 
Previous Employer 2
Supervisor
Date started
Date left
Job Title/ Duties
Pay
Company phone number
May we contact this employer? Yes
No
Previous Employer 3
Supervisor
Date started
Date left
Company phone number
Pay
Job Title/ Duties
May we contact this employer? Yes
No
 

Personal References

Name
Address
Contact #
Name
Address
Contact #
 

Schedule

Date you can start? *
Salary Requirements *
What type of employment are you seeking?? Part time
Full time
What days are you available to work? Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What hours are you available to work?
If required, please check the box(s) in which you would be willing to work * Rotating shifts
Overtime
Saturdays
Sundays
Why have you chosen to work in the home health field? *
 
 
Connect with us
Contact Us

Guardian Angel Home Health and Hospice
2800 N. Hutton Ave
Farmington, NM 87402
PH: 505.564.9002
FAX: 505.564.9022