Apply for Registered Nurse

Become a Care Professional >> Registered Nurse >> Apply

Hello and thank you for your interest in Home Instead. Please fill out the application below and click the Submit button when finished. Fields with an asterisk (*) are required.

Please note that this is the job board for the franchise office located at 800 Broad Street, Shrewsbury NJ 07702. Each Home Instead franchise is independently owned and operated. To find a franchise near you, please visit the Careers page.

For job related questions please call the franchise office at 7325429004.

Summary
Title:	Registered Nurse
ID:	20880
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

Additional Information

* How did you hear about Home Instead?

If applicable, please specify:

Applicant Note & Certification

APPLICANT NOTE

ELA Associates, Inc. is an independently owned and operated Home Instead® franchise 800 Broad Street, Shrewsbury NJ 07702 7325429004.

This application will be valid for 60 days. If you need further assistance for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

This application that you have completed online is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please be sure that you answered all appropriate questions completely and accurately. False or misleading statements during the interview and on your application materials are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law.

CERTIFICATION

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application process may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I also understand that the use of illegal drugs is prohibited when carrying out my job responsibilities. I am willing to submit to drug screening if requested to detect the use of illegal drugs prior to and during employment, as allowed under applicable law.

I understand that this application is not a contract for employment.

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

Administrative Application

This application is for staffing at the Home Instead in Eatontown, NJ only. Please search for the franchise nearest you if you are not from central NJ.

APPLICANT NOTE

ELA Associates, Inc. is an independently owned and operated Home Instead® franchise 25 Main Street, Eatontown, NJ 07724 732-542-9004

INSTRUCTIONS: If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

Please read "Applicant Note" below.
Complete all parts of this application.
Application will be valid for 60 days.

Applicant Note: This application form is intended for use in evaluating your qualifications for employment with us, an independently owned and operated Home Instead franchise. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body is required prior to employment.

PERSONAL INFORMATION

Other Names Previously Used:

	Last Name	First Name	Middle Name
1.
2.

* Have you ever submitted an application here before?

Yes No

If yes, when?

* Have you ever been employed here before?

Yes No

If yes, when?

* Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?

Yes No

AVAILABILITY

Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.

* What date are you available to begin work?

Please Complete all Areas of Availability.

* Full Time or Part Time (check all that apply):

Full Time

Part Time

* Total hours preferred to work per week:

* How many miles from home are you willing to travel?

JOB RELATED SKILLS

Are you certified by the New Jersey Board of Nursing?

R.N. L.P.N. H.H.A. N.A.

License #:

Expiration Date:

Name and Phone Number of the Licensing Agency:

Address of the Licensing Agency:

Dates course was taken (from and to):

Malpractice Insurance Carrier Name, Address and Policy# (if applicable):

To the extent not identified above, list all occupational or professional licenses, training or certificates you have, or other special training you have received, relevant to the position for which you are applying:

To the extent not identified above, please describe any additional work experience you have relevant to your ability to perform companionship and other non-medical services for the elderly?

Certain positions may require the incidental transportation of clients. If you are applying for such a position, please indicate whether you possess a valid drivers’ license issued by the State of New Jersey:

Yes No

Please indicate the date your drivers' license expires:

Is your vehicle insured for personal injury and property damage?

Yes No

Please list the name of the insurance company and the limits of coverage:

Please indicate the date your vehicle insurance expires:

EDUCATION

Please check the highest grade level completed:

	Name	City, State	# Yrs Attended	Graduate?
High School	*	*	*	* Yes No
Vocational/Technical				Yes No
College/University				Yes No

WORK HISTORY

MOST RECENT EMPLOYER

* Are you currently working for this employer?

Yes No

* If yes, may we contact?

Yes No

* Company Name:

* City:

* State:

* Company Phone:

* Dates Employed - From:

* Dates Employed - To:

* Job Title:

* Supervisor's Name:

* Duties:

* Salary:

* Per Hour/Week/Month:

Reason for Leaving:

SECOND MOST RECENT EMPLOYER

Are you currently working for this employer?

Yes No

If yes, may we contact?

Yes No

Company Name:

City:

State:

Company Phone:

Dates Employed - From:

Dates Employed - To:

Job Title:

Supervisor's Name:

Duties:

Salary:

Per Hour/Week/Month:

Reason for Leaving:

THIRD MOST RECENT EMPLOYER

Are you currently working for this employer?

Yes No

If yes, may we contact?

Yes No

Company Name:

City:

State:

Company Phone:

Dates Employed - From:

Dates Employed - To:

Job Title:

Supervisor's Name:

Duties:

Salary:

Per Hour/Week/Month:

Reason for Leaving:

BACKGROUND

As a condition of employment, all employees must be "Bondable".

List states and counties of residence for the past seven (7) years:

County:

State:

County:

State:

County:

State:

County:

State:

* Have you had any moving traffic violations?

Yes No

If yes, please describe:

* Have you been convicted of a felony or misdemeanor in the past seven (7) years?

Yes No

If Yes, please describe below:
(Conviction will not necessarily disqualify applicant from employment. The recency, severity, and pertinence of the conviction to the job will all be considered.)

Incident	City/State	Result

REFERENCES

If you are considered for a position, we may contact your references and would ask that you notify them in advance. Please do not list relatives or family/relations.

Professional References

Full Name	Phone Number	Best Time of Day to Call	Relationship	Number of Years Known
*	*	* AM PM	*	*
*	*	* AM PM	*	*
*	*	* AM PM	*	*

Personal References

Full Name	Phone Number	Best Time of Day to Call	Relationship	Number of Years Known
*	*	* AM PM	*	*
*	*	* AM PM	*	*
*	*	* AM PM	*	*

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I release this company from any liability which might result from making such investigations. I also understand that the use of illegal drugs is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT FOR EMPLOYMENT

By typing your name below you are electronically signing this document.

* Signature (type full name):
* Date:

Screening Questions

* Are you at least 21 years of age?

	Yes
	No

* Do you have your own transportation that is insured?

	Yes
	No

* Are you available to work in Monmouth County?

	Yes
	No

***If you answered No to any of these three questions please stop here. You do not meet our minimum requirements. Thank you for your interest in Home Instead.***

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