Apply for EmploymentAt Trinity Healthcare Services, Inc. To apply for employment, fill out and submit the form below. To add multiple education or past employment entries, click the “Add” button in their respective sections. Employment Form If you are human, leave this field blank. Employee Information Which location are you applying for? * Logan Mingo Name * First Middle * Middle Last * Last Address * Address Address Address City City State/Province State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone * Email * Emergency Contact * Relation to Emergency Contact * Phone * For Emergency Contact Position(s) Applying For * Activities Nursing Dietary Housekeeping Laundry Maintenance Administration Referral Source * Advertisement Friend Relative Trinity Employee Walk-In Employment Agency OtherOther Education School Name Type of School (Elementary, High School, University, College, Graduate, Professional, etc.) Years Completed Degree Received Describe Any Specialized Training: Add Remove Employment Experience Employer Job Title Supervisor Address Address Address Address City City State/Province State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Employment Started Employment Ended (Leave Blank if Still Employed at This Position) Starting Salary/Hourly Rate Ending Salary/Hourly Rate Work Performed Reason(s) For Leaving Add Remove Other Employment Information References * Please list 1-3 references. Give name, address, and phone number for each. References should not be related to you or be past employers. If Employed, And Under 18, Can You Furnish a Work Permit? * Yes No I Am Over 18 Years of Age Have You Filed An Application with Trinity Before? * Yes No Are You Currently, or Have Ever Been, Employed by Trinity? * Yes No What Position? * Are You Related To Anyone Who Works At Trinity? * Yes No Who Are You Related To, And What is the Relation? * Are You Currently Employed At Another Company? * Yes No Can We Contact Your Current Employer? * Yes No Contact Information for Current Employer * Are You Prevented From Work Because of Visa or Immigration Status? * Yes No Special Skills & Qualifications Summarize special skills and qualifications acquired from employment or other experience. Are You a Veteran of the U.S. Military? * Yes No If So, What Branch? * Are there workplace accommodations which would assure better job placement and/or enable you to perform your job and to maintain capability? * Yes No What Accommodations? * Have You Ever Been Convicted of Patient Abuse and/or Neglect? * Yes No Please Explain All Court Actions Taken. * Authorization for Drug Test * Agree Disagree I understand that by submitting this application for employment at Trinity Healthcare Services, Inc., I do consent for drug testing. The results will be released to the administrator of my prospective facility. Agreement (Please Read Below) * Agree Disagree I CERTIFY THE ANSWERS GIVEN HERE ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I authorize investigation of all statements in this application for employment as may be necessary in arriving at an employment decision. I understand this contract is not and is not intended to be a contract for employment. 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 Company. 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