APPLICATION FOR EMPLOYMENT

This application takes approximately 30 minutes to complete. Please be sure to have on hand: Driver's license and previous employer and reference information.

*Indicates a required field.

Position you are applying for: *

__________________________

St. Mary's Nursing Center, Inc. is an equal opportunity employer and does not discriminate against any employee or applicant for employment due to age, sex, marital status, pregnancy, national origin, religion or beliefs, race, color, political affiliation or opinion, handicap, disability, or any other legally protected or non-merit factor.
__________________________

Questions? Contact us here.

 

Do you want to attach a RESUME?
You may do so here. Unfortunately, we cannot accept files over 4M.

Last Name:
First Name:
Middle Name:
Street Address:
City:
State:
Zip Code:
E-mail Address:
Social Security last 4 numbers
(xxx xx - - - - ):
Home Phone (include area code):
Work Phone (include area code):
Cell Phone (include area code):
Date available for work:
Lowest pay you will accept:
Will you accept full-time employment?
Will you accept part-time employment?
DRIVER'S LICENSE
 
Do you have a valid Driver's License?
Driver's License Number and State:
Expiration Date:
Type of License:
Class
List all other professional licenses, registrations and certificates:
Type Number Expiration Date
List all machines or equipment, including office equipment, that you can operate skillfully:
Typing speed: W.P.M.
Additional qualifications and skills:
 
EDUCATION AND TRAINING
Select highest grade completed:
High School
__________________
Name:
City:
State:
Did you graduate?
G.E.D. or equivalent?
College
__________________
Name:
City: State
Did you graduate?
Degree(s):
Major: , Minor
Hours completed:
List additional training, educational seminars, or short courses completed:
REFERENCES
List three persons who are not related to you and who have knowledge of your qualifications. Do not repeat supervisors listed under Experience below.
Name Phone Address Relationship

EXPERIENCE

Starting with your current or most recent job, list all positions you have held in the last ten years. If you consider it appropriate to this application, you may include as an addendum, positions held earlier than ten years ago. Be concise, but do not omit information which may be relevant to the position for which you are applying. Please explain any lapses in employment. You may attach a .txt or .doc (Word document) here.

Current or Most Recent Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
Prior Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
Prior Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
Prior Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
Prior Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
Prior Job - Double click here to expand/contract
Dates of Employment: to
Job Title:
Number of Persons Supervised:
Salary:
Hours Per Week:
Name of Supervisor:
Employer's Phone:
(include area code)
Name and Address of Business or Employer:
Reason for leaving:
May we contact this employer?
If no, why?
 
Description of Duties:
ADDITIONAL INFORMATION
Are you related by blood or marriage to any Nursing Center Employee(s)?
(St. Mary's Nursing Center, Inc. does not prohibit the hiring of relatives. However, it is against our Nepotism policy for an employee to be under the direct supervision of a relative.)
How did you hear about St. Mary's Nursing Center, Inc?
How did you hear of the position you are applying for?
Did a current member of our staff refer you to our facility? Who?
Have you ever been employed by St. Mary's Nursing Center, Inc.?
Date of Employment: to

Position Held:

Reason for Leaving:
Are you legally authorized to accept work and remain in the United States? (Proof of identity and authorization will be required upon employment)
Are you currently 18 years of age or older? If not, state your age:
Can you provide a work permit?
AUTHORIZATION FOR RELEASE OF INFORMATION
It is okay to investigate me. All of the information I provided is true.* 
I have read and agree to the SMNC hiring terms (click here to read). * 



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St. Mary's Nursing Center, Inc. • 21585 Peabody St. • Leonardtown, MD 20650TEL: (301) 475-8000 • FAX: (301) 475-3085
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