Nursing Job Application

SERENITY GLOBAL STAFFING

NURSING JOB APPLICATION

Southfield Campus: 20245 W. 12 Mile Rd., Suite 217 Southfield, MI. 48076. Tel: (248) 828-6562

Applicant Name

Email

Serenity Global Staffing is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below:

Applicant Information

Applicant name

Address

Telephone Number:

Email address

Date

Employment Position

Position(s) applying for: Nursing Job

How did you hear about this position?

What days are you available for work?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

If needed, are you available to work overtime?

YES

NO

Salary Desired

Personal Information

Have you ever applied to or worked for Serenity Global Staffing before?

YES

NO

If yes, when?

Do you have any friends, relatives, or acquaintances working for Serenity Global Staffing

YES

NO

If yes, state name & relationship:

Are you 18 years of age or older?

YES

NO

Are you a U.S. citizen or approved to work in the United States?

YES

NO

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test?

YES

NO

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

YES

NO

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect teh description of the event and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however be considered)

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: Serenity Global Staffing complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Education and Training

High School Name

Location (City, State)

Year Graduated

Degree Earned

College/University

Name

Location (City, State)

Year Graduated

Vocational School/Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

Military

Are you a member of the Armed Services?

Yes

No

Previous Employment

Employer Name

Job Title

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Date Employed

Reason for leaving:

Employer Name

Job Title

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Date Employed

Reason for leaving:

References

Please provide 1 personal and professional reference(s) below:

Reference 1

Contact Information

Reference 2

Contact Information

Additional Information:

Do you have public relation skills?

YES

NO

Upload Resume

AT-WILL EMPLOYMENT

The relationship between you and the Serenity Global Staffing is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Serenity Health Training Institute . No representative of Serenity Health Training Institute has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Applicant Signature:

Dated

Non refundable application fee

Payment methods

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