* Required Information

Personal Information

Full Time Part Time
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
0-50 lbs. 51-100 lbs. 101-150 lbs. 151-200 lbs. 200+ lbs.
Yes No
Yes No

Application Confidentiality Statement

Please read each statement carefully before signing

I understand that this application is not a promise of employment. I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of wages. If accepted for employment, I agree to abide by all policies and procedures. I further understand that I have the right to terminate my employment at any time with or without notice, and Staff Of Life has the same right. No one other than the Executive Director of Staff Of Life has the authority to modify this relationship or make any agreement to the contrary. Any such notification or agreement must be in writing.

I understand that employment by Staff Of Life and the signing of this statement does NOT constitute a contract of employment or guarantee employment for specific length of time.

I understand that the company will investigate criminal background record and may investigate my driving record. As a part of the hiring process, Staff Of Life will be checking references. Staff Of Life may ask questions relating to work experience and opinions that are useful in making hiring decision. Staff Of Life may contact the references listed and may contact past employers and other named in this application to ask any questions relating to work experience and opinions useful to hiring decision. I authorize and release those employers to disclose to the company all records regarding my employment with them. I agree to release this person from legal liability in providing a statement.

Employment History



Education Record

High School


Business or Technical School


Undergraduate College


Graduate School

Employment Agreement

For and consideration of employment of me by Staff Of Life, I do hereby acknowledge and agree as follows: That, during the term of my Employment with Staff Of Life and for one hundred eighty days (180) days after the date of termination, for any reason, of my employment with Staff Of Life, I will not directly or indirectly become employed by any facility I provided services to as an employee of Staff Of Life.

Employee Handbook

I, have received a copy of Staff Of Life Nurse Agency employee handbook and will follow the policies during my employment with this agency.

Position Description

I have received a copy of the position description for my personal records and I understand that it is my responsibility to read and understand the agencies position description.

Resident Rights

I have received a copy of the Resident Rights for long term care facilities and In Home Client Rights. I understand their right and will abide by them.

Employment Reference Letter

Was Employed

I authorize you to release any and all employment reference information.


Was Employed

I authorize you to release any and all employment reference information.

HEDDINGTON OAKS POLICY

As stated in Heddington Oaks contract agency employees attempting to call off less than 2 hours to the start of a shift will have 4 hours deducted from your pay check due to late call in.

I, have read and understand the call in policy for Heddington Oaks.

FACILITY CALL OFF POLICY

As stated in our contracts per facility agency employees attempting to call off less than 2 hours to the start of a shift will have 2 hours deducted from your pay check due to late call in.

I, have read and understand the call in policy.

*
Security code