Employment Want create site? Find Free WordPress Themes and plugins. Your Personal InformationAll prospective employees will receive consideration without discrimination because of race, color, creed, age, origin or handicap. All information provided herein will be kept confidential.Your Name* First Last Your Email Address* Enter Email Confirm Email Your Home Address* Street Address City State Zip Code Your Phone*Mobile PhoneBest Time To Call You*Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly EveningEmergency Contact* First Last Emergency Contact Phone*Have you ever applied for employment with Regal Home Services?* Yes No Hours You Are Available for Work*please tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFridaySaturdaySunday Are you legally eligible for employment in the United States?* Yes No How did you hear about us? Print Ad Regal Employee Other If Regal employee please list.*If other please list.*Are you willing to work* Nights Weekends Neither Position You're Applying ForRegistered NurseLicensed Practical NursePhysical TherapistOccupational TherapistSpeech TherapistCertified Nursing AssistantHome Health AideWhat is your desired hourly or yearly salary?*Which regions do you prefer to work?* Treasure Coast Palm Beach Broward Miami-Dade Keys Are you over the age of 18?* Yes No EducationPlease list your education*please list your previous employers, the dates you worked and the position you heldSchoolLocationCourse of study?YearsDegree Previous EmploymentYour Previous Employers*please list your previous employers, the dates you worked and the position you heldEmployerAddressDatesPositionPhone References*Please list 3 references, at least 2 professional.NameRelationshipStateYears knownPhone Was your last name different form your present name during the above listed jobs* Yes No If yes, what was it First Last Have you completed a level II background screening in the past 5 years?* Yes No If you answered yes to the above question, have you had a gap in employment greater than 60 days? No Yes Have you ever been convicted of a felony in the past 5 years, barring employment in a Home Care and community support Agency?* Yes No A conviction will not necessarily disqualify an applicant from employment.If yes, please explain in detail.CREDENTIALS / SPECIALIZED SKILLS & QUALIFICATIONS / EQUIPMENT OPERATEDList all states in which licensed giving registration and expiration date. Summarize special job-related skills and qualification acquired from employment or other experience.Upload Your Resume Drop files here or Accepted file types: jnp, doc, png, gif, docx, pdf. Upload Your Professional Certificate(s) Drop files here or Accepted file types: jnp, doc, png, gif, docx, pdf. You can upload more than one.Upload Your BLS CPR Card Drop files here or Accepted file types: jnp, doc, png, gif, docx, pdf. The Legal StuffPLEASE READ THE FOLLOWING STATEMENT CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THESE STATEMENTS, PLEASE ASK BEFORE SIGNING. I certify that all answers and statements I have made on this application (and resume or other supplementary materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if discovered at a later date. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment Regal Home Services and for no other reason. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to this job. I also agree to immediately notify the company if I should be convicted of a felony while my application is pending, or during my period of employment, if hired. I authorize any of the persons or organization named in this application to give you complete information and records regarding my employment conduct, performance, and attendance (except for absences covered by law), education, character and qualifications. All former employers who provide such information are indemnified and released from liability arising from such disclosures. All applicant rights to confidentiality and privacy shall be protected in accordance with the law, and all records related to this policy will be preserved in accordance with company policies on privacy and confidentiality of sensitive records. I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the basis for termination. I hereby authorize Regal Home Services to investigate my background and verify this information. I authorize Regal Home Services to release the information contained herein and its findings and work history of my employment to other firms or person upon request.Acceptance* I agree to the Terms and Conditions Date Signature* Save and Continue Later Did you find apk for android? You can find new Free Android Games and apps.