Nurses Care Inc. Application for Employment

Nurses Care Inc.
(513) 424-1141
Online Application for Employment

Personal Information

Name:

SSN#

Present Address (include city & zip)

Permanent Address (include city & zip)

Phone Number

Referred By

Ohio Resident more than 5 years?

Yes No

Employment Desired

Position

Date you Can Start

Salary Desired

Are You Employed Yes No

If yes may we contact your employer? Yes No

Have you ever applied to this company before? Yes No ..(if yes when?)

Have you ever been convicted of a felony? Yes No ..(if yes when?)

Past Education

Name & Location of School

Years Attended

Did you Graduate

Subjects Studied

Grammar:

Yes No

High School:

Yes No

College:

Yes No

Trade, Business, or Correspondence:

Yes No

General

Subjects of Special Study/Research Work

References: Former Employers(list last four, starting with last one first)

Dates Employed	Name or contact Person Address of Employer	Phone #	Salary	Position	Reason for Leaving

Personal Refernces: (List persons, not related to you, whom you have known for at least one year)

Name	Address	Phone #	Business	Years Known

Authorization:
I hereby certify that all questions are fully and correctly answered and I authorize the agency to contact my former employers and all other sources they see fit in order to verify the facts and information furnished with regard to my qualifications.
I hereby release any such employer or persons from any and all liability, whatever in nature, on account of furnishing such information. I understand that any misleading or incorrect statements may render this application void, and if employed, could cause termination.
Should I accept employment with the agency., I acknowledge that no contract of employment exists, implied or otherwise. The policies, benefits, and other prgrams listed in the employee booklet are provided either in compliance with applicable statutes or at the discretion of the agency. This does not imply a contract of employment. The policies, benefits, and other programs offered by the agency, Inc. may be changed or eliminated at the agency's discretion.
Please indicate that you have read and understand the above statements by clicking the Submit Application button below. I understand that a policy of a probationary period of 90 days exists and if employed, the applicant may be terminated if transition is not satisfactory.