3200 Parkway | Big Spring, TX 79720 | (432) 263-4041

Employment | Parkview Nursing & Rehabilitation Center

Parkview Nursing & Rehabilitation
APPLICATION FOR EMPLOYMENT

WE ARE AN EQUAL OPPORTUNITY EMPLOYER
NOTE: ALL EMPLOYEES ARE REQUIRED TO SUBMIT TO PRE-EMPLOYMENT DRUG TESTING
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Position Applying For: If Licensed or Certified, How many years? Date of Application:
How did you hear about us?
If other please explain:
Last Name: First Name: Middle Initial:
Address: City: State: Zip Code:
Telephone Number: Social Security Number:
If you are considered for employment, please list an emergency contact number in case we are unable to reach you at the above number.
Name: Phone Number: Relationship:
If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No
Have you ever filed an application with us before? Yes No
Have you ever been employed with us before? Yes No
Are you currently employed? Yes No
May we contact your present employer? Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Yes No
Proof of Citizenship or immigration status will be required upon employment.    

On what date would you be available for work?

 

Are you available to work:

Full Time Part Time Shift Work Temporary
Are you currently on a "lay-off" status and subject to recall ? Yes No
Can you travel if a job requires it? Yes No
Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment.
Yes No
Have you ever missed work because of an "On the Job Injury"? Yes No
If Yes, please explain:

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Job 1

Job 2

Job 3


EDUCATION
  Name and Address
Of School
Course of Study Years Completed Diploma
Degree
Elementary
School
High
School
Undergraduate
College
Graduate
Professional
Other (Specify)
State any additional information you feel may be helpful to us in considering your application.
REFERENCES

Reference 1

Reference 2

Reference 3

By clicking submit you are agreeing with the applicants statement. Read Statement
Before Clicking Submit please review the information provided above for accuracy.