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APPLICANT INFORMATION

Yes No

Yes No

Yes No
EDUCATION
Yes No

Yes No

Yes No
REFERENCES
Please list three professional references.


PREVIOUS EMPLOYMENT
Yes No

Yes No

Yes No
MILITARY SERVICE
NEXT OF KIN
Full Time Part-Time
On call All
Days (Theory) Days (Clinical)
All
Sun Mon
Tues Wed
Thu Fri
Sat
PROFESSIONAL LICENSURE
APPLICANT DECLARATION
Yes No
Yes No
HANDICAPPED
Investigation required by local, state, or federal laws. I understand that if I am hired by Adonis School of Nursing my employment will be for an indefinite period of time and will be "at will" which means that either Adonis School of Nursing or I may terminate the employment relationship at anytime and for any reason or no reason.

I further understand that, if hired, my at-will employment status may only be changed in written contract signed by the management of Adonis School of Nursing and that no representative of Adonis School of Nursing has the authority to make oral promise to me concerning my employment. Finally, I also understand that Adonis School of Nursing may adopt, from time to time, policies or handbooks dealing with benefits and other terms or conditions of employment. These policies or handbooks do not constitute a contract of employment between Adonis School of Nursing and me. Adonis School of Nursing reserves the right to change or discontinue these policies and / or handbooks at any time with or without notice to me Adonis School of Nursing strives to provide a safe, healthy and productive work environment and supports a smoke free, alcohol-free work environment.
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
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