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Integrity PDN

Private Duty Nursing

Employment application

Job Application

Complete the application below. Fields marked required must be filled in before you can submit.

Applicant information

Your Social Security number is transmitted over a secure connection and stored in our protected backend. It is never included in notification emails.

Availability
Availability type

Hours available each day

Will you work with pets in the home?
Will you perform pet care?
Will you work with a smoking patient/client?
Are you willing to drive?
Do you have a car?
Employment history

List your most recent positions first.

Education

High School

College

Other / Currently studying

Certifications and licenses
Which certifications do you hold?
Military veteran?
Honorable discharge?
Professional references

List three people, excluding relatives or friends.

Skills and experience
Check those that apply
Employment background
Did you receive any discipline in your last 12 months of employment with your previous employer?
Have you ever been discharged or asked to resign from employment?
Personal information
Have you ever applied to or worked for Integrity PDN before?
Do you have any friends, relatives, or acquaintances working for Integrity PDN?
If hired, would you have transportation to/from work?
Are you over the age of 18?
If hired, could you present proof of your legal right to work in the United States?
If hired, are you willing to submit to and pass a controlled substance test?

Integrity PDN complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants and employees to perform essential functions.

Have you ever been included in any exclusion list (OIG/GSA) relative to performing healthcare services?
Have you ever been denied a security bond?
Do you consent to a background check? (We do not share results with third parties.)
Do you have malpractice insurance?

No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date, nature, and circumstances of an offense and its relevance to the position applied for may, however, be considered.

Additional information
Do you speak, write, or understand any foreign languages?
Do you have other experience, training, qualifications, or skills we should know about?
In an emergency, notify
Declaration

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring, and that my answers are true and correct to the best of my knowledge. Any omission or misstatement of material fact may be grounds for rejection of this application or, if employed, termination.

I certify that I have not signed a non-compete, non-solicitation, or other agreement that might restrict me from working for this company.

I understand that if employed, my employment is not definite and may be terminated at any time, with or without notice, by me or the company.

I give Integrity PDN permission to take my photo for company use.

I understand that all arrangements relative to assignments and any modification of terms must be referred to and approved by Integrity PDN, and that I should not make independent arrangements with patients or clients without first consulting the company.

I permit the company to examine my references, employment record, education record, and other information I have provided, and I authorize those references to disclose information about my work record without prior notice to me. I release the company, my former employers, and all other persons and organizations from any claims arising out of such examination or disclosure.

I understand I may be required to qualify for employment based on additional criteria, including competency tests, a background check, or a drug test, and that employment is contingent on satisfactory results. I authorize release of any results to a State or Federal authority requesting such information or in response to a valid subpoena.

Integrity PDN LLC is an equal opportunity employer. This application will not be used to limit or exclude any applicant from consideration on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application or interview process should notify a representative of the organization. This application is kept on file for one hundred twenty (120) days from the date completed.