Apply for Colorado LPN/RN

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Colorado LPN/RN
ID:1035
Location:Colorado
Resume
Resume:
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Contact Information
* First Name:
Middle Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Application Questions
Please complete the questionnaire

Employment Position

* Have you ever applied to or worked for Elite Nurses before?
Yes   No
* Do you have a current healthcare license or certificate?
Yes   No
* How did you hear about this position?
What days are you available for work?
What hours or shift are you available to work?
On what date can you start working?
Do you have reliable transportation to and from work?
Do you have any friends, relatives, or acquaintances working for Elite Nurses?
If yes, state name and relation
* Are you 18 years of age or older?
Yes   No
Can you provide the documents required for the I-9 form (Identification showing proof of who you are and that you are able to work in the United States)?
Yes
No
* Can you pass a criminal background check?
Yes   No
Social Security Number (To run your background)
Date of Birth (To run your background)
* Current employment status
Employed
Unemployed
Student
Other

Job Skills/Qualifications

* Please list below the skills and qualifications you possess for the position for which you are applying.
(Note: Elite Nurses complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/ability and may be subject to a medical examination conducted bt a medical professional.)

Education and Training

Please list all education and/or training that is relevant to the position of which you are applying for.

Previous Employment

Employer Name::
Job Title:
Supervisor Name and  Email::
Employer Address (Not Required if you don't remember):

**If you do not wish for us to contact your current employer please put N/A for the email address.

City, State:
Employer Telephone::
May we contact:
Yes
No
Dates Employed::
Yes
No
Reason for leaving::
Are you still currently working for this company:
Yes
No
If the above answer is yes, do we have permission to contact your current employer?:
Yes
No

Employer Name::
Job Title:
Supervisor Name and  Email:
Employer Address (Not Required if you don't remember):
City, State:
Employer Telephone::
May we contact:
Yes
No
Dates Employed::
Reason for leaving::

Employer Name::
Job Title:
Supervisor Name and Email:
Employer Address (Not Required if you don't remember):
City, State:
Employer Telephone::
May we contact:
Yes
No
Dates Employed::
Reason for leaving::

References
Please provide 3 professional references below:

Reference #1

* Name::
* Phone Number::
Email::
Address::
* City, State:

Reference #2

* Name::
* Phone Number::
Email::
Address::
* City, State:

Reference #3

* Name::
* Phone Number::
Email::
Address::
* City, State:

At-Will Employment


The relationship between you and Elite Nurses is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Elite Nurses. No representative of Elite Nurses has the authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You must understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and the Chief Operations Offices.

* Signature
* Date:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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