Register | Sharon Health Care

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Demographic Information

Upload Resume

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First Name *

Middle Name *

Last Name *

Email *

Address *

City *

State *

Zip Code *

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

Is this a cell phone with texting capabilities? *

I am at least 18 years of age *

Employment Desired

Desired Position(s) *

Date Available *

Have you been employed by SHC before? *

If YES, list date and which facility

Are you related to anyone who works at SHC? *

If YES, list relative's name, facility and department

Are you employed now? *

May we contact your present employer? *

Are you legally able to work in the United States? *

If No, please explain.

Healthcare Worker Background Check

I understand that the information requested below regarding date of birth is for the sole purpose of identification and the accurate gathering of the criminal history record information, and that it will not be used to discriminate against me in violation of the law. I understand that the provision of my Social Security number is required by law.

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 *

References

Please furnish name and phone number of three personal references. These individuals should not be previous employers or relatives.

Reference #1 Name *

Reference #1 Phone *

Reference #2 Name *

Reference #2 Phone *

Reference #3 Name *

Reference #3 Phone *

Educational Background

High School Name *

High School Location (City, State) *

High School Number of Years Completed *

Did you earn a high school diploma or complete GED equivalent? *

College Name

College Location (City, State)

College Number of Years Completed

College Degree Obtained

Graduate School Name

Graduate School Location (City, State)

Graduate School Number of Years Completed

Graduate Degree Obtained

Professional License Type

Professional License Number

Professional License State Issued

Specialized Training

Include where training occurred and type of certification if applicable.

Volunteer Activities

Include specific duties, locations and dates.

Employment Experience

Begin with your present or most recent job. Include military service assignments and internships.

Employer #1 Name *

Employer #1 Address, City, State and Zip *

Employer #1 Supervisor's Name *

Employer #1 Phone Number *

Employer #1 Start Date *

Employer #1 End Date *

Employer #1 Reason for leaving employment *

Employer #1 Position Title and Duties *

Employer #2 Name *

Employer #2 Address, City, State and Zip *

Employer #2 Supervisor's Name *

Employer #2 Phone Number *

Employer #2 Start Date *

Employer #2 End Date *

Employer #2 Reason for leaving employment *

Employer #2 Position Title and Duties *

Employer #3 Name

Employer #3 Address, City, State and Zip

Employer #3 Supervisor's Name

Employer #3 Phone Number

Employer #3 Start Date

Employer #3 End Date

Employer #3 Reason for leaving employment

Employer #3 Position Title and Duties

File Uploads

Cover Letter

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Diploma/Transcripts

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Professional License

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Signature

Electronic Signature - Type Full Name *

By typing my name, I verify that the information contained on this application is correct. I understand that falsifying any portion of this application is grounds for termination.

Register with Sharon Health Care