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If so, please list below:EducationHigh SchoolLocationNumber of years completedAwardsCollegeLocationNumber of years completedMajor/ DegreeGraduate SchoolLocationNumber of years completedMajor/ DegreeOther Schools AttendedLocationNumber of years completedMajor/ DegreeDescribe any additional skills, qualifications, certifications, or training which qualify you for the position(s)Work HistoryEmployer NamePhoneName of SupervisorEmployment DatesStart Pay - End PayTitle - ResponsibilitiesReason for LeavingMay we contact this employer?YesNoEmployer NamePhoneName of SupervisorEmployment DatesStart Pay - End PayTitle - ResponsibilitiesReason for LeavingMay we contact this employer?YesNoEmployer NamePhoneName of SupervisorEmployment DatesStart Pay - End PayTitle - ResponsibilitiesReason for LeavingMay we contact this employer?YesNoAre you able to perform the essential functions of the job(s) for which you are applying?YesNoAre you a Skilled Nurse?YesNoReferencesPlease list any two professional references.NameCompanyJob Title / RelationshipLocationEmail AddressPhoneNameCompanyJob Title / RelationshipLocationEmail AddressPhoneDisclaimer *I certify that the information given by me is true and complete to the best of my knowledge. I understand that if I am employed, the discovery that I gave false information during the application process may result in immediate dismissal. I authorize Grace Health Care Services Inc. to investigate all statements contained in this application and to conduct a background check and request information about me from previous employers, educational institutions, and references. I expressly authorize my previous employers to provide information and opinions concerning my work and work habits. Further, I release Grace Health Care Services Inc. and persons connected with any requests for information from all claims, liabilities, and damages for whatever reason arising out of furnishing any information. If employed, I release Grace Health Care Services Inc. from any liability for future references it may provide regarding my work history at Grace Health Care Services Inc. Due to the large number of applications that Grace Health Care Services Inc. receives, I understand it cannot guarantee that my application will be considered for any or all open positions. In the event of employment, I understand that I am required to abide by all current and subsequently issued rules and regulations of Grace Health Care Services Inc. and that any employment relationship with Grace Health Care Services Inc. is of an “at will “nature. That means I can resign at any time with or without cause or notice and Grace Health Care Services Inc. may terminate my employment at any time with or without cause or notice. Grace Health Care Services Inc. is an equal opportunity employer. Send Message