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  1. Canton Nursing and Rehabilitation Center


    We appreciate your interest in the employment opportunities at Canton Nursing and Rehabilitation Center. Our team includes professionals in Nursing (RN, LPN, CNA, RNA,) Marketing, Housekeeping, Dietary, Laundry, Maintenance, Social Services, Business Office, and Activities!

    Please inquire about current job openings. We commit to hire enthusiastic, professional and compassionate individuals who enjoy coming to work every day.

    You may use this Application for Employment form below to apply for any job.

     

    APPLICANT INFORMATION


  2. First Name / Middle Initial / Last Name*
    Please tell us your name
  3. Address*
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  4. City*
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  5. State*
    Please select one
  6. Zip*
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  7. Phone*
    Please tell us your phone number
  8. Email*
    Please tell us your email address
  1. DESIRED EMPLOYMENT INFORMATION


  2. Date Available*
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  3. Desired Salary*
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  4. Do you need to limit your salary due to Social Security or other reasons?*
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  6. Position Applying For*
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  7. How did you learn of this opening?
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  8. Will you accept another position and if yes, what?*
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  9. Desired Day(s)*
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  10. Desired Shift(s)*



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  11. If You Selected Other Above, Please Tell Us What Are Your Desired Shifts?
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  12. Desired Employment*
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  13. Have You Been Convicted of Any Crime and/or Felony in The Last Seven (7) Years?*
    Please select one
  14. If Yes, Please Explain?
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  1. RESUME

    (If you have a resume you would like to upload please select file and skip to the end of the form. If you do not have a resume to upload, please continue filling out the rest of this form.)


  2. Do you have a Resume to upload*
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  3. Upload Resume
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  1. EDUCATION

     

    High School


  2. High School Name
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  3. Address
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  4. Attended Highschool From
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  5. Attended Highschool To
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  6. Did you graduate?
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  7. Degree
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  8.  

    College


  9. College Name
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  10. Address
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  11. Attended College From
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  12. Attended College To
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  13. Did you graduate?
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  14. Degree
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  15.  

    Other Schooling


  16. Other
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  17. Address
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  18. Attended From
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  19. Attended To
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  20. Did you graduate?
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  21. Degree
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  1. LICENSE/CERTIFICATION


  2. Do you have a State Certification or License?
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  3. If yes, what type?
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  4. Issuing State
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  5. Certificate or License Number
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  6. Has your License/Certification ever been under review, revoked or suspended because of activity related to patient care or the performance of your duties in your profession?
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  7. If yes, please explain
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  1. WORK EXPERIENCE

    List below your work experience, starting with your present or last place of employment.


  2. Are you currently employed?
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  3. May we contact your current employer?
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  4.  

    EMPLOYMENT #1


  5. Date Started
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  6. Date Ended
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  7. Name of Company
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  8. Address
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  9. Phone
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  10. Supervisor's Name
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  11. Job Title
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  12. Salary
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  13. Reason for Leaving
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  14. May we contact your previous supervisor for a reference?
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  15.  

    EMPLOYMENT #2


  16. Date Started
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  17. Date Ended
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  18. Name of Company
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  19. Address
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  20. Phone
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  21. Supervisor's Name
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  22. Job Title
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  23. Salary
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  24. May we contact your previous supervisor for a reference?
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  25.  

    EMPLOYMENT #3


  26. Date Started
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  27. Date Ended
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  28. Name of Company
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  29. Address
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  30. Phone
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  31. Supervisor's Name
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  32. Job Title
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  33. Salary
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  34. Reasons for Leaving
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  35. May we contact your previous supervisor for a reference?
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  1. MILITARY SERVICE


  2. Branch
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  3. Attended From
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  4. Attended To
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  5. Rank at Discharge
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  6. Type of Discharge
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  7. If other than honorable, explain:
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  1. SPECIALIZED TRAINING / SKILLS / ORGANIZATIONS


  2. Please list any specialized training or skills you have that you consider relevant to the job in which you are applying for. You may also list any professional groups or organizations you belong to.
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  1. REFERENCES

    List below at least two people not related to you whom you have known for at least one year.

    REFERENCE #1


  2. Full Name
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  3. Relationship
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  4. Company Name
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  5. Phone
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  6. Address
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  7.  

    REFERENCE #2


  8. Full Name
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  9. Relationship
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  10. Company Name
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  11. Phone
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  12. Address
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  13.  

    REFERENCE #3


  14. Full Name
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  15. Relationship
    Invalid Input
  16. Company Name
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  17. Phone
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  18. Address
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  1. Disclaimer and Electronic Signature

    I Understand:

    This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age, physical, mental disability unrelated to ability to perform the work required.

    No question on this application is intended to secure information to be used for such discrimination.

    I voluntarily give this institution the right to make a thorough of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take the physical examination, and such future examinations as required by this institution at such times and places as the institution shall designate. I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties i would be required to perform.

    If employed, I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling change as directed by my department head or administrator of this institution.

    I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without Cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

    If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.


  2. Please Read and Approve The Information Above by Checking Below*
    Please authorize that you have read and approve the information above.

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