First Name:

Last Name:

Address:

Check the appropriate boxes below:
RN  BSN  LPN  NAC   

Phone: (___)___-____

Cell: (___)___-____

E-mail address

How did you hear about Alliance? select one Craigslist Flyer Seattle Times Washington Nursing Commission News Other newspaper Work Source Referral Other

Referred by:

Preferred Work Area: Homecare Adult Family Home Visits All

Have you ever worked in homecare? If yes, how long?

Most recent experience?

How far are you willing to commute?

Do you have? (Check all that apply)
Current WA nursing license 
First Aid 
Current CPR card 
Food Handlers Permit 
Have taken 7 hr AIDS/HIV Training 
Vaccine History 
Current TB Test

Homecare/Hospital Experience: (Check all that apply)
Vent
Trachs
IV
Adults
Peds
Multiclient
School Nursing
Long Term Care
Clinic
ICU
Psych
ER

Shifts Preferred:
Days
Eves
Nights
Part-time
Full-time

FYI TO PROSPECTIVE EMPLOYEE:

1. Alliance will require current copies of your nursing license, nursing school diploma and/or transcripts, CPR card, WDL, and evidence of TB.
2. We will need 2 references before hire
3. In homecare, we cannot guarantee full- time days; flexibility with shift preference is a plus.
4. Drug free work place; pre-employment drug testing on site.
5. For licensed nurses: written medication exam.
6. A TB test within 3 days of hire will be required, even if testing has recently been completed. The exception to this is if applicant has previously tested positive, in which case a negative chest x-ray is required (no time limit on when x-ray was done). If no TB testing in the last year, a two step PPD will be required, so bring any TB info. Testing may be done at Alliance Nursing or the Health Dept. at no cost.