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Act Now DME Application
Desert Tech Pros
2020-12-06T17:22:32-07:00
Act Now DME Application
Application for Prospective Act Now DME Employees
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Act Now DME Application
PLEASE OPEN THIS PAGE IN CHROME, INTERNET EXPLORER, OR SAFARI
Thank you for choosing Act Now DME:
Healthcare professionals are always in high demand. We know you have a choice in employment and we are happy you have decided to join Act Now DME.
Act Now DME is RN owned and operated.
Our company allows for employees to enjoy a safe work environment with flexibility and a meaningful and rewarding job experience. As a healthcare professional, you make the difference – between life and death, comfort and pain, knowledge and fear, freedom and dependence. Imagine having that feeling every day. Working in the healthcare field is a noble profession. Here at Act Now DME understand what it is to work with and care for patients. We are here to assist you and give to you in all of your pursuits.
Act Now DME knows that all healthcare workers are overworked and under-appreciated but “we are the helping hands of healthcare.” We value and care about all those who come through our doors. We want for all those in healthcare careers to have a better life: one with great autonomy, financial compensation and have the ability to be independent and happy in your practice as a healthcare worker.
Act Now DME is on the forefront of technology, allowing you to see your payroll on-line, up-to-date schedule, and complete all charting from a computer. Our website allows you to input your information and availability when it is convenient for you 24 hours a day. We will not contact you on the days that you show you are not available for shifts.
We are focused on service to you and community development both locally and nationally. There are many benefits that we would like to share with you.
Sincerely:
The Act Now DME Staff
Office: (520)442-2411
Email: hr@actnowd1.sg-host.com
Employee Information
Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Position Applying For:
*
Education
Type of Degree / Certification (Check One)
*
RN
LPN
NP
PA
MA
CNA
HHA
PT
ST
OT
MSW
BSW
Other
If Other, Please List Degree / Certification Here:
Professional License/ Technical Certificate
State
License
Exp. Date
Special Certications (Include Expiration Dates)
*
CPR/BLS
ACLS
Pals
Other
Education/CEU
*
School Name-Location
Program
Years
Graduate (Y/N)
Degree
Experience
Previous Expierence
Acute
Ambulatory Care
Ambulatory Serivces
Age Specific Competencies
Neonates / Newborns (BIRTH – 30 Days)
Infants (30 Days – 1 Year)
Toddlers (1 – 3 Years)
Preschooler (3 – 5 Years)
Older Children (5 – 12 Years)
Adolescent (12 – 18 Years)
Younger Adult (18 – 40 Years)
Middle Adult (40 – 64 Years)
Older Adults / Geriatrics (64+ Years)
Additional Information
Have you ever held a professional license under an alternate name?
*
Yes
No
If "Yes" list that name here:
*
Have you ever had any professional disciplinary action taken against you or against any of your licenses?
*
Yes
No
Is there any reason Act Now DME would not be able to assign you to any employer that you listed?
*
Yes
No
Are there any reasons why we could not contact your current employer?
*
Yes
No
Are you tired of answering questions yet If “Yes” hang in there. You’re almost finished!!!
*
Yes
No
If “Yes” to any of the above questions include an explanation below. Note: A “Yes” to any of the above questions will NOT necessarily reject your application.
*
Are you a United States of America Citizen?
*
Yes
No
If “No” to the above, do you have a “Resident Alien Card” or “Work Permit”? List Alien Number and attach.
*
LIST YOUR LAST THREE (3) EMPLOYERS BEGINNING WITH YOUR MOST RECENT EMPLOYER.
Resumes are accepted but do not replace your application.
Current or Most Recent Employer:
Company Name
*
Position/Title Held
*
Start Date
*
Month
Day
Year
End Date
*
Supervisor Contact Information
*
Name
Email
Phone Number
Rate of Pay
Reason For Leaving
*
Employer Two:
Company Name
*
Position/Title Held
*
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Supervisor Contact Information
*
Name
Email
Phone Number
Rate of Pay
Reason For Leaving
*
Employer Three:
Company Name
*
Position/Title Held
*
Start Date
*
Month
Day
Year
End Date
*
Month
Day
Year
Supervisor Contact Information
*
Name
Email
Phone Number
Rate of Pay
Reason For Leaving
*
Professional References
Please add a minimum of three references.
*
Name
Relationship
Email
Phone Number
Years Known
Notification & Agreement
Note: You must agree to ALL fields below to complete your application.
I certify that all answers and statements I have made on this application (and any other accompanying or required documents) are true and complete without omissions. I understand that any falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
*
Yes
No
I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between Act Now DME or myself for employment for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President or Vice President
*
Yes
No
I hereby authorize any of the persons of organizations named in the application (or other accompanying or required documents) to give you complete information and records regarding my employment, education, character and qualifications. This application is valid for only ninety (90) days from the date signed. If I want to be considered for job openings more than ninety (90) days from date signed, I will submit a new application.
*
Yes
No
Applicant Signature
*
Print Complete Name
*
Date Signed
*
Month
Day
Year
Please Upload Your Professional Resume/CV Below:
Please note:
If you do not have any of these files immediately available, please send any requested documents to
hr@actnowd1.sg-host.com,
This WILL delay the processing of your application.
File
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg, Max. file size: 256 MB.
Captcha
Please fill out the captcha to complete your application.
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