<title>Employment Application

CARING NURSES OF MICHIGAN, INC
EMPLOYMENT APPLICATION

The equal opportunity laws entitle applicants to consideration for employment without regard to race, color, gender,religion, age, national origin, marital or veteran status, non-disqualifying disability, or any other legally protected status, except in the event of a bona fide occupational qualification, as that phrase has been defined by law.

Last Name    First Name      Middle  

Address  

City        State         Zip  

Telephone Number(s)        Social Security No.  

Pager No.       Emergency Contact No.  

Fax No.         Alternate No(s).  

Please answer all questions completely.
Yes No     Are you 18 years or older?

Yes No     Are you legally eligible to work in the USA?

Yes No     Have you filled an application here before?   If yes, date(s)

Yes No     Have you been employed here before?   If yes, date(s)  

If yes, name under which employed, if different  

Names of any friends or relatives already employed here  
Yes No     Have you ever been convicted of a crime or do you have any felony charges pending?

If yes, please explain  

(A conviction will not automatically bar you from employment. Each conviction will be evaluated individually, with consideration of such factors as the nature and background of the offense, the date of the conviction and the sentence imposed. all known circumstances will be considered.)

PAST AND PRESENT EMPLOYERS

Start with your present or most recent job and include military service assignments.

Employer 1  
Address     

City              State            Zip  

Telephone Number(s)   

From(M/Y)      To(M/Y)  

  Hourly Rate/Salary(Starting)   Hourly Rate/Salary(Ending) 

Describe the work you did



Reason for Leaving  

Supervisor's Name   
Employer 2  
Address     

City                State            Zip  

Telephone Number(s)   

From(M/Y)      To(M/Y)  

  Hourly Rate/Salary(Starting)   Hourly Rate/Salary(Ending) 

Describe the work you did

>

Reason for Leaving  

Supervisor's Name   
Employer 3  
Address     

City                            State              Zip  

Telephone Number(s)   

From(M/Y)      To(M/Y)  

  Hourly Rate/Salary(Starting)   Hourly Rate/Salary(Ending) 

Describe the work you did

>

Reason for Leaving  

Supervisor's Name   
Employer 4  
Address   

City                 State            Zip  

Telephone Number(s)   

From(M/Y)      To(M/Y)  

  Hourly Rate/Salary(Starting)   Hourly Rate/Salary(Ending) 

Describe the work you did

>

Reason for Leaving  

Supervisor's Name

EMPLOYMENT DESIRED

Position Applied For    Date  

Kind of Work Sought   Full Time   Part Time   Other  

Have you been given a job description or had the job requirements explained to you?  Yes No

Can you perform the requirements of this job, either with or without reasonable accomodation?  >Yes No

Please indicate any specialized skills you posses that relate to the position(s) applied for    

EDUCATION

High School      Years Completed    Diploma/Degree   

Undergraduate College     Years Completed Diploma/Degree

Graduate/Professional   Years Completed Diploma/Degree

Other(Specify)     Years Completed Diploma/Degree

(List technical, professional licenses or certificate of teaching.

REFERENCES

List individuals who have knowledge of your work accomplishments, experience and abilities (Do not include relatives).

Last Name   First Name   Middle  
Address

City State   Zip  

Telephone Number(s)    Occupation  

Relationship      Years Known    ).

Last Name   First Name   Middle  
Address

City State   Zip  

Telephone Number(s)   Occupation  

Relationship Years Known  

Last Name   First Name   Middle  
Address

City State   Zip  

Telephone Number(s)   Occupation  

Relationship Years Known   ).

Last Name   First Name   Middle  
Address

City State   Zip  

Telephone Number(s)   Occupation  

Relationship Years Known   .

Last Name   First Name   Middle  
Address

City State   Zip  

Telephone Number(s)   Occupation  

Relationship Years Known  


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For more information:
Caring Nurses of Michigan
39475 W. 13 Mile Rd.
Suite 100
Novi, MI 48377 US
Email: caringnurses@aol.com
(248) 355-1142

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