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Position Applying For: *

Name *

First

Last

Email *

Address *

Address Line 1

City

State

Zip Code

Phone Number *

Expected Pay

Would you work full-time?

Would you work part-time?

What date would you be available to work?

What is the best time to call you?

How were you referred to us?

Have you ever submitted an application here before?

If yes, please provide date(s) and Position(s).

Have you ever been employed at RPNT before?

If yes, please provide date(s).

Is this an application a request for reemployment following an extended military leave of absence?

If yes, additional information may be requested.

If you are under 18 years of age, can you provide a work permit if required?

Are you able to perform the "essential functions" of the job for which you are applying (with or without accommodation)?

Yes
No
Need more information about the job's "essential functions" to respond

NOTE: This question is not designed to elicit information about an applicants disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage, to the extent permitted by law.

Will you travel if required?

Will you work overtime if required?

Are you able to meet the attendance requirements of the position?

Have you ever been bonded?

Please provide your drivers licence number (if driving is required for this job).

Have you ever entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict you from working for our company?

If yes, please explain.

Applicant Statement *

I have read and agree to the terms of the Applicant Statement.

APPLICANT STATEMENT: I hereby certify that the information contained in the employment application I submit to RPNT Acute Services is true and complete to the best of my knowledge. I understand that any omissions or falsification of this application in any detail may result in my disqualification from consideration for employment or for dismissal from employment. I also understand that my employment is subject to a satisfactory check of references. I give RPNT Acute Services the right to investigate the information given and to secure additional information if necessary. I authorize my previous employers, educational institutions, and all other individuals and organizations listed in this application form to give information about my employment, work habits, and character. I agree that RPNT Acute Services and my previous employers, educational institutions, and all other individuals and organizations listed in this application will not be held liable in any respect if an employment offer is not made, is withdrawn, or if my employment is terminated because of misrepresentations or omission of requested information. I understand that upon offer and acceptance of a position with RPNT Acute Services I will be required to immediately furnish documentation establishing my identity and eligibility to be legally employed in the United States. I understand that RPNT Acute Services is in no way obligated to provide employment, and also that I am in no way obligated to accept employment, if offered. This application does not bind either party, and the statements contained herein do not constitute and should not be interpreted to constitute any sort of contract of employment for a specific period of time.

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