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First Name *

Middle Name *

Last Name *

Email *

Phone *

I would like to receive updates about my application from Sharon Health Care sent to my mobile number. Message and data rates may apply. Message frequency varies. Reply STOP to opt-out or HELP for assistance. Privacy Policy & Messaging Terms

I am at least 18 years of age *

Desired Position(s) *

Have you been employed by SHC before? *

Have you ever been convicted of a crime, other than traffic offenses? *

If YES, please furnish date(s), type of offense, sentence, etc.

As a prospective employee, I understand the requirements of the Healthcare Worker Background Check Act. *

The Health Care Worker Background Check Act requires health care employers to conduct Illinois State Police criminal history record checks on employees who have responsibility for direct care and who are not otherwise licensed by the Illinois Department of Professional Regulation or the Department of Public Health. In long-term care facilities, the law primarily applies to certified nurse aides. As the result of criminal history record checks, persons with disqualifying convictions in any of 28 areas may not work in a position having direct care responsibilities without a waiver issued by the Department.

Date of Birth *

Social Security Number *

Professional License Type

Professional License Number

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