Annex Healthcare Employee Application for Nursing Care

Are you a nurse interested in amazing opportunities? Have you ever considered the advantages of Annex Healthcare Providers, inc. and what home health can offer you? Do you love where you live, but want to hear about new job opportunities? Or are you making a move to a new location and need a job when you get there Annex Healthcare Providers, Inc. is the right choice.

We are Annex Healthcare Providers, Inc. a highly appraised Home Healthcare company.

Benefits, Benefits, and more Benefits!

We are currently seeking Nurses for assignments locally in a variety of specialties.

Online: Complete the application and submit it directly to us for immediate review.

Fax: Download the Pdf Application and fax the completed form to us at 818-985-8505.

Employment Application

Adobe Acrobat required to open application, if you do not have it, install it here.

Questions about the online application? Call 818-509-2661.

Annex Healthcare Providers, Inc.
16633 Ventura Blvd. Suite #540
Encino, CA 91436

Phone: (818) 509-2661
Fax: (818) 985-8505

Questions? Contact Pani@annexhealthcare.com

Employment Application

*POSITION(s) YOU ARE APPLYING FOR:

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List additional qualifications, professional and civic activities that may be helpful to us in considering your application:
Email:
First Name:
Last Name:
Middle Initial:
Address:
City:
State:
Zip:
Home Phone:
Alt Phone:
Persons to notify in case of emergency? :
Type of School:
School Training:
Schools Name and Location:
School years completed:
Degree obtained:
High School:
Vocational education:
College or University:
Post Graduate:
Other Educational or Special T:
Other Languages you speak, read, and write fluently:
Degree or Certificate:
If you are under 19 years of age, can you provide required proof of your eligibility to work?	One Two Three
Are you currently employed?:	One Two Three
May we communicate with your present employer?:	One Two Three
If you are not a citizen do you have the right to work?:	One Two Three
If hired, on what date will you be available to start work?:	Month Year
Do you have any prior or pending legal claims? Please explain.
How did you learn about us:
Other:
Employer Name 1:
Employer Address 1:
Job Title 1:
Start Date 1:
Start Date 1:
End Date 1:
End Date 1:
Supervisor Name 1:
Employer Telephone 1:
Reason For Leaving 1:
Job Title and Work Performed 2:
Employer Name 2:
Employer Address 2:
Job Title 2:
Start Date 2:
Start Date 2:
End Date 2:
End Date 2:
Supervisor Name 2:
Employer Telephone 2:
Reason For Leaving 2:
Job Title and Work Performed 3:
Employer Name 3:
Employer Address 3:
Job Title 3:
Start Date 3:
Start Date 3:
End Date 3:
End Date 3:
Supervisor Name 3:
Employer Telephone 3:
Reason For Leaving 3:
REFERENCES (Other than relatives or former employers)
Reference #1: (Please include, Name, Address, and Telephone)
Reference #2: (Please include, Name, Address, and Telephone)
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby acknowledge that any employment relationship with this company is an "AT WILL" nature, which means that the Employee may resign at any time and the Employer may discharge a Employee at any time with or without cause. It is further understood that this "AT WILL" employment relationship may not be changed by any written document or by conduct unless such changes is specifically acknowledged in writing by an authorized Executive of the Company. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer. Signature of Applicant: (place initials in box to sign)