• Consolidated Medical Staffing Application

  • Personal Information

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  • Referral Information

  • General Information

  • If yes please complete the following:

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  • A “yes” answer will not automatically disqualify you from being considered as a candidate for employment. Convictions will be considered based on the time and nature of the offense and their relationship to the job applied for.

  • Education

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  • Other Information

  • Employment History

  • Please list your job history for the past ten years (or last six employers) starting with your most recent. Please complete this section in addition to forwarding an updated resumé and, noting any periods in which you were not employed, please include Military Service.

  • Employer-1

  • Employer-2

  • Employer-3

  • Employer-4

  • Employer-5

  • Employer-6

  • Licensure

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  • If yes to any of these questions, please attach separate sheet with full explanation.

  • Availability

  • Please mark the shifts on the days that you would be available for work.

  • Preferences

  • Reporting of Abuse Policy

  • Verbal or physical abuse, neglect, or misappropriation of client facility's or patient/resident's property by our Employees will not be tolerated. Any Employee determined to have committed an act of verbal or physical abuse toward a patient or resident of any medical or long-term care facility will be immediately terminated.                                      

    It is every employee's responsibility to immediately report any incidents of actual or suspected abuse to their supervisor, unless the immediate supervisor is the alleged perpetrator. In that case the report is to be made to the local Consolidated Medical Staffing office immediately.

    Any Employee who fails to immediately report any suspected abuse or neglect of a resident will face disciplinary action up to and including termination of employment.

    No reprisal act shall be taken against any employee who reports instances of patient rights violation or patient abuse, neglect or exploitation to the appropriate governmental authority.

  • EEOC Policy

  • It is the policy of Consolidated Medical Staffing to assure equal employment opportunity practices to all applicants and employees without regard to race, creed, color, religion, national origin, sex, pregnancy, sexual orientation, disability, veteran status, military status, marital status, or any other protected status in accordance with applicable federal, state, and local laws. This policy governs all areas of employment with Consolidated Medical Staffing, including, but not limited to, recruiting, hiring, training, assignments, promotions, compensation, benefits, discipline and terminations. We support all employment laws regarding equal opportunity, discrimination, and affirmative action.

  • Notifications and Acknowledgments

  • I hereby declare that all statements contained in this application are true and correct and that I understand that false or inaccurate information in this application may be considered grounds for immediate termination. I hereby authorize Consolidated Medical Staffing to investigate my applicable background history inclusive of prior employers, driving records, credentials, Licenses, criminal and professional disciplinary histories, and to verify this information. I understand that if employed , my employment will not be for any fixed period of time and I or Consolidated Medical Staffing may terminate my employment at any time. I also authorize Consolidated Medical Staffing to release information pertaining to my application to, and work history with Consolidated Medical Staffing, subject to applicable privacy and other laws, to entities making valid, legal requests for such information. I understand that I may be expected to work on a variety of job assignments within the scope of my training/credentialing, and within any geographical areas per my agreements with Consolidated Medical Staffing. I understand that Consolidated Medical Staffing will attempt to assist me to expedite and maximize my recovery if I become ill or am injured in their employ, and therefore agree to accept light, or modified duty assignments that may be offered to me. I understand my failure to report to Consolidated Medical staffing for work, including light and/or modified duty assignments, will indicate I have voluntarily quit, thereby relinquishing any claim for unemployment benefits. I also agree to submit to a drug screen upon request or as specified in Consolidated Medical Staffing’s substance abuse policy.

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