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Basic Information
Please provide some basic contact information. This will help us communicate any opportunities to you as quickly as possible.
First Name
MI
Last Name
Name:
First Name
Middle Initial
Last Name
Nickname:
Address:
Address Line 2
City:
State / Province:
- All -
Zip/Postal Code:
Country:
- All -
Afghanistan
Albania
Algeria
American Samoa
Argentina
Australia
Austria
Bangladesh
Barbados
Belarus
Belgium
Belize
Bermuda
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Czech Republic
Denmark
Egypt
Estonia
Finland
France
Germany
Gibraltar
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Korea
Kuwait
Latvia
Lebanon
Liechtenstein
Lithuania
Luxembourg
Malaysia
Mexico
Morocco
Mozambique
Myanmar
Netherlands
New Zealand
Nicaragua
Nigeria
North Korea
Norway
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Romania
Russian Federation
Saudi Arabia
Singapore
Slovakia (Slovak Republic)
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syrian Arab Republic
Taiwan Province Of China
Thailand
Tunisia
Turkey
Ukraine
United Arab Emirates
United Kingdom
United States
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Yugoslavia
Current Employer:
Current Title:
Available Date:
Desired Compensation:
Wage Ammount
Wage Currency
-Select Currency-
US Dollar
Wage Frequency
-Select Frequency-
Annually
Bi-Weekly
Hourly
Monthly
Weekly
Referral:
Type
Source
AACN News
Advance for Imaging and Radiation Therapy
Advance for Medical Laboratory Professionals
Advance for Nurses
Advance for Occupational Therapy
Advance for Physical Therapists and PT Assistants
Advance for Respiratory Care Practitioners
Advance for Speech Lang Pathologists & Audiologist
American Assoc of Respiratory Care (www.aarc.org)
American Association of Physical Therapy
American Journal of Health System Pharmacists
American Nursing Assoc Nursing World (www.ana.org)
American Occupational Therapy Assoc (www.aota.org)
American Pharmacist Association
American Society of Radiologic Technologist (ASRT)
AORN Journal
Cath Lab Digest
Critical Care Nurse
Direct Mail
E-mail
Employee
ENA Connection Newsletter
Hypodermic
Imprint
Job Fair
Journal of Emergency Nursing
Journal of Nuclear Medicine
NC Board of Nursing
NCpharmacists.org
News & Observer
Nursing Direct
Nursing Spectrum
Open House
Opportunities in Nursing
Other
Pharmacy Week
PT Bulletin (www.apta.org)
Radio
RT Image
Television
WakeMed Website
www.google.com
www.medhunters.com
www.nursingcenter.com
Yahoo! HotJobs (www.hotjobs.com)
-Select One-
Telephone Numbers
Tell us the numbers where we can reach you.
Type
Number
Primary
Best Time
Home:
Work:
Mobile:
Fax:
Other:
Resume
A resume, either pasted or typed into the resume field, is required.
Paste your resume here from any word processor.
Education
Please provide details regarding your level of education.
What is your highest level of education completed?
Please provide the name of the educational institution (high school, technical school, college, university).
Please provide the city and state where you received your degree.
Credentials
To be completed by licensed / registered / certified applicants only.
License 1 Type
License 1 Date Received
License 1 License #
License 1 State
License 1 Expiration Date
License 1 Renewal #
License 2 Type
License 2 Date Received
License 2 License #
License 2 State
License 2 Expiration Date
License 2 Renewal #
Has your license ever been revoked, suspended, or denied in any state?
- Select One -
Yes
No
If yes, what state? Please explain the circumstances.
Is your license currently under investigation?
- Select One -
Yes
No
If yes, explain.
References
Please list professional references (other than friends or relatives) in the section below. Please include their full name, job title, company name, city/state and telephone number.
Reference 1
Reference 2
Reference 3
Security Information
Your response to any of these security questions will not automatically disqualify you from employment. However, if you answer "no" and a criminal history is found or if you answered "yes" but did not include all convictions you will be disqualified from consideration.
Have you ever been convicted (pleaded guilty or been found guilty) of a criminal offense, misdemeanor or felony (including, but not limited to, writing bad checks & DWI)?
- Select One -
Yes
No
If you answered Yes above, give dates and explain.
Presently, do you have any pending charges?
- Select One -
Yes
No
If you answered Yes above, give dates and explain.
Have you ever had any adverse legal actions imposed by Medicare, Medicaid or any other federal agency or program?
- Select One -
Yes
No
If you answered Yes above, give dates and explain.
Pre-Employment
All offers of employment with WakeMed are contingent upon the successful completion of pre-employment references, drug testing, a Criminal Background Investigation, and licensure and education verification (as applicable). Should you be extended an offer of employment, you would be scheduled for a drug test prior to your start date. During the reference checking process, a Criminal Background Investigation will also be conducted. In order for us to conduct the Criminal Background Investigation, we will need you to provide a list of counties where you have lived for the past seven (7) years.
List the Counties and States where you have lived during the past seven (7) years.
Work Experience
Starting with your most recent position, provide the details of your last three employers. If you are a student or do not have any work experience, please leave blank. If these details are provided in a resume, you are not required to complete this section.
Please list the actual dates of your current or last position (Example: May 2003 - Jan 2006).
Provide the place of employment, job title and duties.
Name, title and telephone number of supervisor.
List reason for leaving.
What is (was) your rate of pay?
How many hours per week did you work in this position?
Please list the actual dates of prior position (Example: May 2003 - Jan 2006).
Provide the place of employment, job title and duties.
Name, title and telephone number of supervisor.
List reason for leaving.
What was your rate of pay?
How many hours per week did you work in this position?