HME Clinical Support Specialist; PRN

Position: Flexible HME Clinical Support Specialist (PRN)

Personal Information

• Current Address *
• Apartment/Unit
• City *
• State *
• Phone Number *
• Email *
• Job Applied For: *
• Annual Salary Desired *

Are you applying for full-time or part time? *

Full Time

Part Time

Are you applying for full-time or part time? *

Full Time

Part Time

Are you applying for full-time or part time? is required

Would you consider working:

Yes

No

I would consider working:
Weekends & Holidays *

Yes

No

Whether you will work Weekends & Holidays is required

I would consider working:
On Call *

Yes

No

I would consider working:
On Call
* Yes No

Whether you will work On Call is required

I would consider working: 1st Shift *

Yes

No

I would consider working: 1st Shift
* Yes No

Whether you will work 1st Shift is required

I would consider working: 2nd Shift *

Yes

No

I would consider working: 2nd Shift
* Yes No

Whether you will work 2nd Shift is required

I would consider working: 3rd Shift *

Yes

No

I would consider working: 3rd Shift
* Yes No

Whether you will work 3rd Shift is required

I would consider working:
Rotating Shift

Yes

No

Have you ever worked for this facility?

Yes

No

Have you ever worked for this facility? Yes No

Whether you have prior employment with this facility is required

• Friend/Relative Name
• Department
• Relationship

Do you have friends or relatives that work for this facility? *

Yes

No

Do you have friends or relatives that work for this facility?
* Yes No

Whether you have friends or relatives who work for this facility is required

Are you 18 years of age or older? *

Yes

No

Are you 18 years of age or older?
* Yes No

Whether you are 18 years of age or older is required

Are you a US Citizen or Alien legally authorized to work in the United States? *

Yes

No

Are you a US Citizen or Alien legally authorized to work in the United States?
* Yes No

Whether you are a US Citizen or Alien legally authorized to work in the United States is required

Education/Skills and Professional Licenses High School

• High School Name *
• Address *

Last Year Completed *

1 2 3 4

Last Year Completed
* 1 2 3 4 Last Year Completed is required

Did You Graduate? *

Yes

No

Did You Graduate?
* Yes No

Whether you graduated is required

• List Diploma or Degree *

College

• College Name
• Address

Last Year Completed

1 2 3 4

Last Year Completed 1 2 3 4 Last Year Completed is required

Did You Graduate?

Yes

No

Did You Graduate? Yes No

Whether you graduated is required

• List Diploma or Degree

Other Business College or Special Courses

• Special Military Training, Post Graduate and Nursing
• Area(s) of specialization or major interest
• List office skills including computer/software experience
• Word Processing (Approx. WPM)

Professional Licenses

Professional License or Registration

Currently Licensed Currently Registered Eligible for License Eligible for Registration

Professional License or registration ever suspended, revoked, or on probation?

Yes

No

• Type
• State
• Number
• Date

Professional Certifications

Currently Certified Eligible for Certification

Do you have another previous employment? *

Yes

No

• Do you have another previous employment?
  * Yes No Whether you have another previous employment is required

Previous Job #2

• Job Title *
• Employed From *
• To *
• Company Name *
• Address
• City
• State
• Duties *
• Reason for Leaving *

Do you have another previous employment? *

Yes

No

• Do you have another previous employment?
  * Yes No Whether you have another previous employment is required

Previous Job #3

• Job Title *
• Employed From *
• To *
• Company Name *
• Address
• City
• State
• Duties *
• Reason for Leaving *

Do you have another previous employment? *

Yes

No

• Do you have another previous employment?
  * Yes No Whether you have another previous employment is required

Previous Job #4

• Job Title *
• Employed From *
• To *
• Company Name *
• Address
• City
• State
• Duties *
• Reason for Leaving *

Please identify and explain any gaps in employment longer than three (3) months

Upload Resume

Accepted formats: .pages, .doc, .docx, .pdf, .png, .jpg

Select files from your computer
or simply drag & drop them here

Carefully read this section prior to hitting submit.

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete.

I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that I will be required to satisfactorily complete a drug, alcohol and tobacco use screening as a condition of employment.

Graham Health System is committed to providing a safe and healthy work environment and to promote the health and well-being of their employees.

Provision of Information

I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information. *

Provision of Information I hereby authorize persons, schools, my…