* = Required Information
Applicant Information
Yes No
Yes No
Yes No
Yes No
Education
Yes No
Yes No
Yes No
References

Please list three professional references.

Previous Employment
Company 1
Yes No

Company 2
Yes No

Company 3
Yes No
Military Service
Next of kin
40/WK <40/WK On call Any
Days Evenings Nights Any

Sun       Mon      Tues      Wed      Thu      Fri      Sat     
Professional Licensure
Applicant Declaration
Yes No
Yes No
Yes No
Handicapped

Investigation required by local, state, or federal laws. I understand that if I am hired by Adonis College of Nursing my employment will be for an indefinite period of time and will be "at will" which means that either Adonis College of Nursingor I may terminate the employment relationship at anytime and for any reason or no reason.


I further understand that, if hired, my at-will employment status may only be changed in written contract signed by the management of Adonis College of Nursing and that no representative of Adonis College of Nursing has the authority to make oral promise to me concerning my employment. Finally, I also understand that Adonis College of Nursing may adopt, from time to time, policies or handbooks dealing with benefits and other terms or conditions of employment. These policies or handbooks do not constitute a contract of employment between Adonis College of Nursing and me. Adonis College of Nursing reserves the right to change or discontinue these policies and /or handbooks at any time with or without notice to me. Adonis College of Nursing. strives to provide a safe, healthy and productive work environment and supports a smoke free, alcohol-free work environment.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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