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Milner Application

Thank you for your interest in Milner Community Health. Milner is an Equal Opportunity Employer.

Full Name (*)

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Street Address (*)

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State (*)

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Zip Code (*)

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Your Email (*)

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Current Phone (*)

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Other Phone Number

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Wage Expected

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Available to work (*)

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List any restrictions on days andor hours you are unavailable for work.

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Are you 18 years of age or older? (*)

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Have you ever been employed here? (*)

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If yes give reason for leaving

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Please tell us about your education

High School with complete address and did you finish? If not what grade was completed? (*)

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College with complete address and did you finish? If not what year was completed?

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Nursing School with complete address and did you finish? If not what year was completed?

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Any special schooling or training? Provide address and list specials.

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Professional Licenses

Licenses Type, State, Date, Number

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Licenses Type, State, Date, Number

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Employment History List all previous employers for whom you have worked during the last five years. Explain any lapses between times when employed.

Name of employer, complete address, start date, end date, position & location, Supervisor and reason for leaving.

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Name of employer, complete address, start date, end date, position & location, Supervisor and reason for leaving.

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Name of employer, complete address, start date, end date, position & location, Supervisor and reason for leaving.

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Name of employer, complete address, start date, end date, position & location, Supervisor and reason for leaving.

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Name of employer, complete address, start date, end date, position & location, Supervisor and reason for leaving.

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