Application form


Full- Time Nights


12 Hour Shifts, Nights/Weekends/Holidays

Previous Experience Required

Minimum of 1 year FT experience as a LPN preferred. Must be current with CPR.

Specialized or Technical Education Required

Must be a graduate of an accredited school of practical nursing, and be currently licensed by the State Board of Nursing. Membership in an LPN organization is encouraged.

Manual or Physical Skill Required

Physical Effort Required

Must possess good physical health. Required to stand for long periods of time. Lifting and transporting of patients is required. Motor coordination and manual dexterity are necessary. Strength: Medium; Push: Occasionally; Pull: Occasionally; Carry: Occasionally; Lift: Occasionally; Sit: Occasionally; Stand: Frequently; Walk: Frequently


Personal Information

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Referral Information

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Placement Information

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High School

*All below fields are required.


Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

Previous Employer 1

Previous Employer 2


*All below fields are required.

Reference 1

Reference 2

Reference 3

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