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ETS APPLICATIONS
Just Say The Word, We Can Do It All!
ETS APPLICATIONS
Just Say the Word, We Can Do It All!
Full Name
Middle Name
Last Name
Date of birth
Address
City
ZIP CODE
Phone
*
Cell Phone
*
Email
*
Referred to us by
Position(s) applied for
CNA/ PCT
Nursing
Other
Type of employment desired
Per Diem/ Temp. Staffing
Temp. to permanent
Contract
Date Available
Other
Day shift or Night shift
If currently employed, may we contact your employer?
Yes
No
Rate of Pay Expected $
Is there a specific reason you are applying for employment with this agency?
Yes
No
If Yes, please briefly outline the reason:
Are you 18 years or older?
Yes
No
Are you legally eligible for employment in this country?
Yes
No
Have you ever served in the military?
Yes
No
If yes, branch of service?
Honorable or Dishonorable discharge?
Are you available to work overtime if required?
Yes
No
Have you applied with ETS before?
Yes
No
Have you been employed with this agency before?
Yes
No
Do you have any friends or family employed with ETS?
Yes
No
If yes, when?
Have you been convicted of a crime in the last seven (7) years?
Yes
No
If yes, please explain
CONVICTION WILL NOT NECESSARILY BE A DISQUALIFICATION FOR EMPLOYMENT.
If considered for hiring, will you agree to provide a criminal background check?
Yes
No
If considered for hiring, will you agree to provide a controlled substance test?
Yes
No
EDUCATIONAL BACKGROUND
List previous three (3) educational institutions attended, beginning with the most recent.
School
CITY, STATE/PROVINCE
GRADUATED?
Yes
No
DEGREE(s)/DIPLOMA(s) Earned
What Nursing or relevant designations, licenses or registrations if any, do you possess?
Type
Date of Most Recent Registration
Valid in State/Province ?
Yes
No
BLS
Yes
No
ACLS
Yes
No
PALS
Yes
No
Last Certified
Last Certified
Last Certified
PLEASE ANSWER THE FOLLOWING QUESTIONS
What do you think is the most difficult part of nursing or customer service work?
What was the best job you ever had and why?
What was your least favorite job and what did you dislike about it?
Think of the BEST supervisor you have ever had, what characteristics made that person a good manager?
Think of the WORST supervisor you have ever had, what characteristics made that person a poor manager?
How will you be able to contribute to providing patients with high quality care?
EMPLOYMENT BACKGROUND
Provide the following information beginning with the most recent employer.
Employer
Telephone
Address
JobTitle
IMMEDIATE SUPERVISOR AND TITLE AND PHONE NUMBER
MAY WE CONTACT FOR REFERENCE?
Yes
No
Later
DATES EMPLOYED (From)
TO
HOURLY RATE/SALARY (STARTING)
Per
HOURLY RATE/SALARY (FINAL)
Per
SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES
Second
Employer
Telephone
Address
JobTitle
IMMEDIATE SUPERVISOR AND TITLE AND PHONE NUMBER
MAY WE CONTACT FOR REFERENCE?
Yes
No
Later
DATES EMPLOYED (From)
To
DATES EMPLOYED (From)
Per
HOURLY RATE/SALARY (FINAL)
Per
SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES
Third
Name
Employer
Telephone
Address
JobTitle
IMMEDIATE SUPERVISOR AND TITLE AND PHONE NUMBER
Yes
No
Later
DATES EMPLOYED (From)
TO
Per
HOURLY RATE/SALARY (STARTING)3
Per
SUMMARIZE THE TYPE OF WORK PERFORMED AND JOB RESPONSIBILITIES
REFERENCES
List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).
Name refers
RELATIONSHIP
YEARS ACQUAINTED
Phone/Mobile
Name refers
RELATIONSHIP
YEARS ACQUAINTED
Phone/Mobile
Name refers
RELATIONSHIP
YEARS ACQUAINTED
Phone/Mobile
I certify that all the information I have provided is true, complete and correct.
The information contained within this application or any cover letter or resume attached is not shared with any third parties. The information is used by the employer only as an aid in the hiring decision making process. The applicant, by signing the application gives the employer consent to collect the information contained herein and use for the purpose specified. I authorize this company to investigate all statements contained on this application.
I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal.
I understand that if I am hired, I will be required to provide criminal background check at my cost, proof of identity and legal authority to work in the United States, proof of certifications or educational qualifications).
AT-WILL EMPLOYMENT
he relationship between you and Entruss Staffing, LLC 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 Entruss Staffing, LLC. No representative of Entruss Staffing, LLC 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.
Agree
*
Agree
