Job Category: Registered Nurse Team LeaderJob Type: Full Time Part TimeAs a member to the interdisciplinary team, the registered nurse team leader assumes responsibility and accountability for nursing services delivered to all residents of a designated unit for one shift. Registered nurse team leader provides direct care, administers treatments and medications, organizes and distributes daily assignments to direct care staff consistent with staff competency and each individual residents comprehensive resident assessment and plan of care. Supervises direct care staff and makes decisions about resident care needs during shift within scope of clinical competence, consistent with facility policies and procedures.1234PERSONAL INFORMATION First *MiddleLast *Other and/or Previous Names Used (if applicable)Address * Street Address Address Line 2 City State ZIP CodePhone *Email *Are you at least 18 years of age? YesNoWhich position are you applying for?If you are applying for CNA, LPN, or RN- Professional License Number * If you DO NOT have a professional license number, please enter: 00000License TypeHave you ever been employed with RCCC? * YesNoIf yes, when?Have you ever held a license in another state? (CNA, LPN, or RN) * YesNoIf yes, where?Are you authorized to work for wages in the United States? * YesNoIf you answered 'Yes', you will be required to present documentation showing your employment authorization and identity.Have you ever been employed in another state? * YesNoIf yes, where?Have you been convicted of a criminal offense within the last (7) years? * YesNoIf yes, please explain:Do we have your authorization to perform a background check? * YesNoEMPLOYMENT DESIRED Position You Are Applying ForDaysEveningsNightsAnyDate you can startType of Work Full TimePart TimeEDUCATION Highest level of education you have completed?Name of last school attended?Degree attained?Vocational or trade training?REFERENCES List below three people not related to you.REFERENCE #1Name First LastAddress Street Address Address Line 2 City State ZIP CodePhoneEmailIn what capacity do you know this person?REFERENCE #2Name First LastAddress Street Address Address Line 2 City State ZIP CodePhoneEmailIn what capacity do you know this person?REFERENCE #3Name First LastAddress Street Address Address Line 2 City State ZIP CodePhoneEmailIn what capacity do you know this person?WORK EXPERIENCE List below your work experience, starting with your present or last place of employment.EMPLOYMENT #1 Dates of Employment Start DateEnd Date End DateName of CompanyAddress Street Address Address Line 2 City State ZIP CodePhoneSupervisor's NamePosition HeldReason for LeavingEMPLOYMENT #2 Dates of Employment Start DateEnd Date End DateName of CompanyAddress Street Address Address Line 2 City State ZIP CodePhoneSupervisor's NamePosition HeldReason for LeavingEMPLOYMENT #3 Dates of Employment Start DateEnd Date End DateName of CompanyAddress Street Address Address Line 2 City State ZIP CodePhoneSupervisor's NamePosition HeldReason for LeavingInformation for Government Monitoring Purposes The following information is requested by the Federal Government in order to monitor compliance with applicable Federal Civil Rights laws. The law states that a provider of services may neither discriminate on the bases of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations, the provider of services is required to note race, ethnicity, and sex on the basis of visual observation or surname.I do not wish to furnish this informationDate:Not Hispanic or LatinoHispanic or LatinoMark One Race WhiteBlack or African AmericanAmerican Indian/Alaskan NativeAsianNative Hawaiian or Other Pacific IslanderSome Other RaceTwo or More RacesMark one or moreSex FemaleMaleResume Accepted file types: onlyacceptspdfs, Max. file size: 64 MB. Please attach your resume here.#J-18808-Ljbffr

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