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Shore Staffing, Inc.

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EMPLOYMENT APPLICATION

Please complete this application, click on SUBMIT, and once we review your application and you meet our requirements, we will be in touch. Our policy is to require you to provide documentation of your eligibility to work in the US, copies of your licensure and certification(s), provide full and accurate information regarding former employers, and to complete all of our paperwork to include competency testing, references, background check and submit to a drug screen.

We ask for an open, professional communication between you and us. We will be here for you, assist you in any way possible, and we expect a professional, courteous, and open communication from you at all times. Our staff is our lifeline. Our staff will tell you that we are here to listen to your needs and we trust you to be dependable, honest and professional at all times. Thank you in advance for your cooperation. If you have any questions, call us at 410-957-2800.

First Name: *
Last Name: *
Street Address: *
City: *
State: *
Zipcode: *
Other Names you have worked as:
Date you are available to work:
Home Phone Number: *
Email address: *
Cell Phone Number: *
Date application completed:
Position applying for (RN, LPN, GNA, CNA, etc): *
Best time to call: *
Specialty: *
Licensure or Certification: *
Education Level: *
College Attended: *
Degree: *
Graduation date (college): *
Have you ever been convicted of a crime other than a minor traffic violation (DUI is not considered a minor violation)? If yes, please give details and status: *
State of Licensure and expiration date: *
Has your license or certification ever been investigated or suspended?: *
Most recent or current employer (Facility Name): *
Dates of employment (to/from): *
Supervisor's Name and phone number: *
Reason for leaving: *
Position held: *
May we call your current employer: *
Previous (#2) Employer (Facility Name): *
Position held: *
Reason for leaving: *
Dates of employment (to/from): *
Supervisor's Name and phone number: *
Previous (#3) Employer (Facility Name): *
Dates of employment (to/from): *
Position held: *
Reason for leaving: *
Supervisor's Name and phone number: *
Have you held any other jobs in the last 15 years? Answer Yes or No. If yes, please complete the additional portion in full detail: *
BY SUBMITTING THIS APPLICATION, I CERTIFY THAT I UNDERSTAND THE FOLLOWING:
1. Any false answer or statement on this application or in the interview process will be considered sufficient cause for denial of employment or termination of employment if discovered after commencement of employment. The same holds true when deliberately omitting information.2. Shore Staffing is an at-will employer and that my employment may be terminated with or without cause, without notice, at anytime, at the discretion of Shore Staffing. 3. Nothing contained within this employment application or the in the granting of an interview shall be construed as an employment contract between Shore Staffing and me. 4. I give Shore Staffing the right to contact all of the above professional references for the purpose of obtaining an assessment of my competence, work ethic, dependability, and reliability. I RELEASE THE ABOVE PROFESSIONAL REFERENCES and their respective employers/companies from all liability for providing such information in good faith. * ANSWER YES OR NO: *
Please verify your application with your name followed by the last 4 digits of your SS#: *