FIRST NAME *MIDDLE NAMELAST NAME *PHONE *CELL PHONEEMAIL ADDRESS *DATE OF BIRTH:ADDRESS *CITY *STATE *ZIP *ARE YOU A US CITIZEN? *YESNOIF NO, ARE YOU AUTHORIZED TO WORK? *YESNOHAVE YOU EVER WORKED FOR AMERICAN STAFFING BEFORE? *YESNOHAVE YOU EVER COMMITED A FELONY? *YESNOIF YES EXPLAIN *HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? *YESNOIF YES, EXPLAINTRANSPORTATIONCarBusOtherPOSITIONEDUCATIONHIGH SCHOOLVO-TECHCOLLEGEPOST-GRADUATESKILLSend Message Golden Arms Health Care LLC | Job Interest Form Interested in working at Golden Arms Health Care LLC? Please complete the form below: "*" indicates required fields When do you intend to start working?*Application Date*First Name*Last Name*Phone Number*Email*Highest Level of Education*High SchoolCertificate (less than 6 months training)College (2 year associate degree)University (4 year bachelors degree)MastersDoctorateName of School/College/University*Are you eligible to work in the USA?*YesNoWhich job position are you interested in?*Caregiver / Resident AssistantNursing AssistantClinical Nursing (RN/LPN)What availabilities do you have?*Casual/On CallPart-TimeFull-TimeMost preferred shift*MorningEveningsNightsPlease select the shift (s) that you are available to workMorning (7:00am – 3:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evening (3:00pm – 11:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Nights (11:00pm – 7:00am)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Are you available to work other shifts (other than selected above) ?*Not Available to work other shiftsMorning ShiftsEvening ShiftsNight ShiftsMorning (7:00am – 3:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evening (3:00pm – 11:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Nights (11:00pm – 7:00am)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Additional notes/requests regarding your scheduleDo you have current Mantoux or Chest X-ray results?*YesNoDo you have a reliable means of transportation?*YesNoDo you have a valid driver's license?YesNoEqual Opportunity Employer StatementGolden Arms Healthcare LLC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.Consent* Please type your name below to certify that all the information on this form is true and correct.First Name*Last Name* Golden Arms Health Care LLC | Job Interest Form Interested in working at Golden Arms Health Care LLC? Please complete the form below: "*" indicates required fields When do you intend to start working?*Application Date*First Name*Last Name*Phone Number*Email*Highest Level of Education*High SchoolCertificate (less than 6 months training)College (2 year associate degree)University (4 year bachelors degree)MastersDoctorateName of School/College/University*Are you eligible to work in the USA?*YesNoWhich job position are you interested in?*Caregiver / Resident AssistantNursing AssistantClinical Nursing (RN/LPN)What availabilities do you have?*Casual/On CallPart-TimeFull-TimeMost preferred shift*MorningEveningsNightsPlease select the shift (s) that you are available to workMorning (7:00am – 3:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evening (3:00pm – 11:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Nights (11:00pm – 7:00am)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Are you available to work other shifts (other than selected above) ?*Not Available to work other shiftsMorning ShiftsEvening ShiftsNight ShiftsMorning (7:00am – 3:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evening (3:00pm – 11:00pm)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Nights (11:00pm – 7:00am)* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Additional notes/requests regarding your scheduleDo you have current Mantoux or Chest X-ray results?*YesNoDo you have a reliable means of transportation?*YesNoDo you have a valid driver's license?YesNoEqual Opportunity Employer StatementGolden Arms Healthcare LLC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.Consent* Please type your name below to certify that all the information on this form is true and correct.First Name*Last Name* Application Form
