SCNC Employment Application

Page 1 of 5     Application for Employment     1. Position(s) Desired         2. Social Security Number*         3. Today's Date*   mm/dd/yyyy       4. Last Name*         5. First Name*         6. Middle Name         7. Are you under age 18?*   Yes   No       8. Present Address: Street & Number*         9. Present Address: City*         10. Present Address: State*         11. Present Address: Zip Code*         12. Email Address         13. Home Area Code & Phone*         14. Work Area Code & Phone         15. Best Time to Contact         16. For employment verification purposes has your name been legally changed in the last ten years?*   Yes   No       17. Current Name         18. Current Name Since Date   mm/dd/yyyy       19. Former Name         20. Former Name Since Date   mm/dd/yyyy       21. Former Name         22. Former Name Since Date   mm/dd/yyyy       23. How did you become aware of this position?*   Advertisement   Job Posting   St. Catherine's Employee   St. Catherine's Website   Other, please specify               24. Are you interested in:*   Full Time   Part Time   PRN       25. Shift you are available to work:*   Day   Evening   Night   8 Hour Shifts   Weekend   Holiday   Any       26. Have you ever been employed at this facility and/or other Daughters of Charity facility*   Yes   No       27. If yes, indicate date, position and location:         28. Do you have any relatives employed at this facility?*   Yes   No       29. If yes, list names, departments and location:         30. If hired, can you furnish proof that you are eligible to work in the United States?*   Yes   No       31. If no, explain: