Must be at least 18 years of age Must have reliable transportation Must have current car insurance Must not have been convicted of a felony Must pass a background check Must have a high school diploma or GED Must have an active Missouri RN license RN – Employment Application Fill out the form completely and be sure to double-check your email address and phone number. Your contact information Please fill out the form completely. * First Name * Last Name MI * Street Address * City * ST * Zip * Phone Alternate Phone Email Availability What days and hours are you available to work? * Are you currently employed? Yes No May we inquire of your current employer? Yes No Expected salary Hourly or annualy Have you ever applied here before? Yes No When did you apply here before? At which location did you apply? Select Bolivar El Dorado Joplin/Webb City Springfield * Which location would you like to apply for? Choose Location Bolivar El Dorado Joplin/Webb City Springfield Easy Living, Inc. operates in Bolivar, El Dorado, Joplin, Webb City and Springfield, Missouri. * When can you start? * How many hours per week? What hours are you available? * Monday * Tuesday * Wednesday * Thursday * Friday * Saturday * Sunday Education High School Diploma or GED minimum. * Your highest level of education Please Select High School Diploma or GED Some College (No Degree) Associates Degree Bachelors Degree Masters Degree High School Did you graduate? No Yes GED College/University Degree, Major or Subjects Studied Did you graduate? No Yes Technical School Subjects or Classes Taken Certificate(s) Additional Training MANDT Yes CPR/First Aid Yes Medication Aid Level 1 Yes Please list other relevant training Mobility Current Drivers License Yes No Current Car Insurance Yes No Requires Proof of Insurance on hire. Do you have RELIABLE transportation? Yes No Employment History Where have you worked before? Start with the most recent. Most Recent Employer Start Date Is this your current employer? Yes No End Date Phone Salary Hourly or annually Reason for leaving Second Most Recent Employer Start Date End Date Phone Salary Hourly or annually Reason For Leaving Third Most Recent Employer Start Date End Date Phone Salary Hourly or annually Reason For Leaving Fourth Most Recent Employer Start Date End Date Phone Salary Hourly or annually Reason For Leaving Personal References Contact information for 3 people, not related to you that you've known for at least 1 year. * Reference 1 First Last * Address * Phone Business/Occupation * Years Known * Reference 2 First Last * Address * Phone Business/Occupation * Years Known * Reference 3 First Last * Address If no phone please add mailing address or email address. * Phone Business/Occupation * Years Known About You Referred by? Are you able to work with or without reasonable accomodations? Why do you want to work for Easy Living, Inc.? Why do you want to change jobs? What abilities/qualities do you possess that will help you in this job? Check For Errors Or Omissions If you click the 'Apply' button below and you are not directed to a confirmation screen, scroll up and make sure you filled in all required fields marked with a red *. Authorization By submitting this form, I certify that the facts contained in this application are true to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. l authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company for ail liability for any damage that may result from utilization of such information.