Camp Carew Nurse at Kemmerer Village

First Name *

Last Name

Address *

Phone *

Email *

Referral Source *

Are you over 21 years of age? *

Have you filed an application here before? *

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? *

Please choose what type of work you are available for.

Full Time
Part Time
Shift Work
Temporary

On what day would you be available for work?

Are you on lay-off and subject to recall?

Do you have a valid driver's license? *

If Yes, List State

Can you travel if required for a job? *

Would you be willing to use your car for agency related transportation for mileage reimbursement? *

If Yes, Name of Car Insurance Carrier

Have you ever been convicted of a felony or had a case of child abuse founded against you? *

If Yes, please explain.

Are you a veteran of the U.S. Military Service? *

If Yes, please list the Branch.

Please summarize and special skills and qualifications acquired from employment or other experience and list years of experience in respective field.

Please state any additional information you feel may be helpful to us in considering your application.

Please list your current or most recent place of employment (Job #1). Please include the employer's name, address and phone number. Please do NOT put "See Resume". This section must be filled out in its entirety.

Please list your job title at this position (Job #1).

Please include the dates employed from the first date of employment to the last date of employment (Job #1).

Please list the work performed at this position (Job #1).

Please list the reason for leaving this position (Job #1).

Please list your next place of employment (Job #2). Please include the employer's name, address and phone number. Please do NOT put "See Resume". This section must be filled out in its entirety.

Please list your job title at this position (Job #2).

Please include the dates employed from the first date of employment to the last date of employment (Job #2).

Please list the work performed at this position (Job #2).

Please list the reason for leaving this position (Job #2).

Please list your next place of employment (Job #3). Please include the employer's name, address and phone number. Please do NOT put "See Resume". This section must be filled out in its entirety.

Please list your job title at this position (Job #3).

Please include the dates employed from the first date of employment to the last date of employment (Job #3).

Please list the work performed at this position (Job #3).

Please list the reason for leaving this position (Job #3).

Please list three references who are not related to you and are not previous employers. Please list name, address and phone number.

Please list any foreign languages you may speak, read and/or write. Please list if you speak fluently/good/fair.

Do you have your High School Diploma?

If Yes, please list the school you obtained your High School Diploma from.

If No, Do you have your G.E.D.?

Please list your highest level of College. Please include your diploma/degree, course of study and honors received.

To further assist us into the consideration of your application, feel free to attach a cover letter and resume below.

You may attach a Resume here.

You may attach a Cover Letter here.

Nothing on this application is intended to create or imply a contractual relationship. If hired, the employee understands that employment is at will, i.e., is not for any specific time period or duration and can be terminated with or without cause at any time by the employer or employee. Please choose below. *

Kemmerer Village may investigate all statements contained in this application and I understand that any false or misleading information provided on any of the application or during the interview process will result in withdrawal from consideration for employment (or my immediate discharge if I am hired) regardless of when discovered. Please choose below. *

I understand that Kemmerer Village provides care for behavior disordered adolescents who may at times exhibit aggressive behaviors towards themselves, other residents or staff. Please choose below. *

Please sign below that you agree to all conditions stated above. By typing your name and date, you agree to the above listed conditions. *

See all the jobs at Kemmerer Village here: http://kemmerervillage.recruiterbox.com/jobs

Application Form