Download employment application - Southview Acres Health Care Center

INTERNAL EMPLOYMENT APPLICATION
SOUTHVIEW ACRES HEALTH CARE CENTER
2000 OAKDALE AVENUE, WEST ST. PAUL, MN 55118
Tel: 651-554-9500
Fax: 651-451-9538
PLEASE PRINT IN INK, COMPLETING ALL INFORMATION
Personal Information
Date
First Name
Last Name
Current Job Title
Best Telephone Number
Employed from month/year
Current Supervisor
Current Dept/Unit
Current Position
Desired Dept/Unit
Desired Position
Current Shift:
AM PM NOC
Desired Shift:
AM PM NOC
Current HRS
Desired HRS
Have you been in your Current Position for 90 days?
 No
 Yes
Are you currently under any type of Performance and/or Attendance Improvement within the facility?
 No  Yes
NOTE: If you have not been in your current position for 90 days or are in a Performance
and/or Attendance Improvement process, you are NOT eligible for a position change.
Why do you believe you are the best candidate for this position?
I certify, to the best of my knowledge, that all information given by me in this application is true and correct. I
understand that false or misleading statements made by me or consequential omissions of any kind in the application
process are sufficient cause for my not being hired or for my dismissal if I am already employed no matter when
discovered.
I understand that if hired, my employment is not for any definite period of time or successions of periods, is not
governed by any written or oral contract, and is considered an “at-will” arrangement. This means that either
Southview Acres or I am free to terminate my employment at any time for any reason, so long as there is no violation
of applicable law.
Signature
Date
RETURN THIS APPLICATION TO SCHEDULING (FOR NURSING) OR THE DIRECTOR OF THE DEPARTMENT
(OTHER THAN NURSING).
EMPLOYER USE ONLY
RECEIVED _______/_______/ _______ BY: ____________ IS THE SHIFT AVAILABLE? :
YES
NO
COPY TO __________ (CURRENT MANAGER) ON _______/_______/ _______
YES
NO, Why? _____________________________________________________________________________
COPY TO __________ (PROSPECTIVE MANAGER) ON _______/_______/ _______
YES
NO, Why? _____________________________________________________________________________
Employee Notified: _______/_______/ _______
 HR
Southview Acres Health Care Center is an AA/EEO employer.
Revised by: MC 8/1/13