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Employee Opportunities
Desired Position: Registered Nurse
First Name *
Last Name *
Middle Initial *
Other Name(s)
Social Security # *
Salary Desired *
Are you over 18 *
Yes No
Zip Code*
Home Phone *
Alt. Phone
Referred By
Have you ever interviewed with Restore Healthcare?* Yes No
Have you ever been employed by Restore Healthcare?* Yes No
Do you have any relatives employed by Restore Healthcare?* Yes No
Background History
Legislature for the State of Texas mandates that persons convicted of certain crimes may not be employed in most facilities and agencies providing medical care or business providing services related to those facilities. As a result, a background check is required before employment.
Have you ever been convicted, pleaded no contest, or quilty to any offence. (A "yes" response does not necessarily disqualify your application)* Yes No
General Information
Contact my current employer for reference
I am willing to work overtime
I would be able to perform the job function with or without reasonable
Main Office & Mailing Address
C.H.A.P. Accredited Agency
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