Careers

Please submit the application below to be considered for one of our open positions

Applicant Information
Name *
Address *
Address Line 2
City *
State *
Postal Code *
Home Phone *
Mobile Phone *
Email Address *
Location
Date of Birth *
Education & Training
High School *
College *
School *
Degree Received *
Professional Training
Name of School & Location *
Number of years attended
Did you graduate? *
Professional Certification
Desired Employment
Position you are applying for:*
Desired Salary
Start Date *
Are you currently employed?*
May we contact your most current Employer?*
Have you ever worked with this Company?*
Who referred you to Reliable Care? *
ARE YOU ELIGIBLE To WORK IN THE UNITED STATES? *
(Proof of employment authorization/eligibility including Birth Certificate, Driver’s License, Copy of Social Security card, CPR Certifications, Professional License, Criminal background check using CJIS # will be required before employment)
Employment History
Please provide your most recent positions of employment.
Employer1 *
Supervisor *
Phone Number *
Address 1 *
Address 2
City *
State *
Postal Code *
Date Employed *
To *
Employer2 *
Supervisor *
Phone Number *
Address1 *
Address2
City *
State *
Postal Code *
Date Employed *
To *
References
Professional References1
Name *
Business Address
Street Address *
Address Line 2
City *
State *
Zipcode *
Email Address *
Phone *
Business
From *
To *
Professional References 2
Name *
Business Address
Street Address *
Address Line 2
City *
State *
Zipcode *
Email Address *
Phone *
Business
From *
To *
Have you been convicted of a crime in the last 5 Years?*
CERTIFICATION
Check all that apply *
State *
SKILLS
The following information will help us place you where your skills, knowledge of nursing and preferences will be best suited
Can you do vital signs *
Can you do ostomy care? *
Can you do catheter care? *
Can you insert catheters? *
Can you start IVs? *
Do you suction patients *
Can you set up oxygen for patients? *
Have you trained on PALS [PEDS ADVANCED LIFESUPPORT]? *
Can you give IV medications? *
Can you assess patients for admission? *
Do you have PICS BLS [CPR] experience? *
PREFERENCES
Are you a licensed driver? *
Will you travel 30 minutes one way? *
Will you work private duty cases? *
Select the time of day you are available *
Select your days of availability *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How many hours a week do you wish to work? *
Do you have any physical limitations that would hinder your work as a nurse? *
If yes, please describe *
Malpractice Insurance
Do you have professional Liability Insurance? *
Insurance Name *
Policy No. *
IF APPLYING FOR HOMECARE YOU MUST HAVE THIS INSURANCE!
I certify that the foregoing answers to the questions asked in this application are true to the best of my knowledge. Misstatement or omission of material facts may be cause for dismissal.
Signature/ Title *
Date *
If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct of Reliable Care LLC. This application will remain active on file for 60 days. If I am hired within this period, this form will be transferred to my individual personal file. If I am not hired or have not heard from this agency within 60 days, this application will no longer be active and I will need to reapply for employment if I wish to be considered for a job with Reliable Care. I do hereby give the employer and/or its agents, including consumer-reporting bureaus, the right to investigate any and all statements made in this application for the purpose of employment and retention of employment. This investigation may include, but not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. If required, I agree to a drug-testing prior and during employment or for post-accident occurrences. Further, I hereby release from liability and hold harmless Reliable Care LLC, it’s representative, all persons and organizations/companies for furnishing such information. DISCLAIMER: The employer, Reliable Care LLC is an Equal Opportunity Employer. The employer does not discriminate in employment and no questions on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law. Reliable Care LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status NOTICE: This is to inform you that as part of processing your employment application, we may obtain a consumer report, which includes information as to your character, general reputation, personal characteristics and mode of living. If an investigative report is requested, you have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. By signing below, you acknowledge receipt of a copy of this notice and a copy of the “Summary of Your Rights under the Fair Credit Reporting Act.”
Signature *
Date *

COVID-19 Information

Careers

Careers

Please submit the application below to be considered for one of our open positions

Applicant Information

Education & Training

Professional Training

Desired Employment

(Proof of employment authorization/eligibility including Birth Certificate, Driver’s License, Copy of Social Security card, CPR Certifications, Professional License, Criminal background check using CJIS # will be required before employment)

Employment History

Please provide your most recent positions of employment.

References

Professional References1

Business Address

Professional References 2

Business Address

CERTIFICATION

SKILLS

The following information will help us place you where your skills, knowledge of nursing and preferences will be best suited

PREFERENCES

Malpractice Insurance

IF APPLYING FOR HOMECARE YOU MUST HAVE THIS INSURANCE!
I certify that the foregoing answers to the questions asked in this application are true to the best of my knowledge. Misstatement or omission of material facts may be cause for dismissal.

Reliable Care Services

Quick Links

Locate Us

Business Hours

Copyright © 2021 Reliable Care Services

Privacy Policy

Terms of Use

COVID-19 Information

Careers

Please submit the application below to be considered for one of our open positions

Applicant Information

Education & Training

Professional Training

Desired Employment

(Proof of employment authorization/eligibility including Birth Certificate, Driver’s License, Copy of Social Security card, CPR Certifications, Professional License, Criminal background check using CJIS # will be required before employment)

Employment History

Please provide your most recent positions of employment.

References

Professional References1

Business Address

Professional References 2

Business Address

CERTIFICATION

SKILLS

The following information will help us place you where your skills, knowledge of nursing and preferences will be best suited

PREFERENCES

Malpractice Insurance

IF APPLYING FOR HOMECARE YOU MUST HAVE THIS INSURANCE! I certify that the foregoing answers to the questions asked in this application are true to the best of my knowledge. Misstatement or omission of material facts may be cause for dismissal.

Reliable Care Services

Quick Links

Locate Us

Business Hours

Copyright © 2021 Reliable Care Services

Privacy Policy

Terms of Use

IF APPLYING FOR HOMECARE YOU MUST HAVE THIS INSURANCE!
I certify that the foregoing answers to the questions asked in this application are true to the best of my knowledge. Misstatement or omission of material facts may be cause for dismissal.