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Application For Employment (Restorative Aide)

Application for Employment (Restorative Aide)

Applicant’s Information
Which job are you interested in? * Required
First * Required
Last Name * Required
Address * Required
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone * Required
E-Mail * Required
Date Available * Required
MM slash DD slash YYYY
Desired Salary * Required
Desired Shift * Required
Are you a citizen of the United States? * Required
- Yes
- No
If no, are you authorized to work in the U.S.? * Required
- Yes
- No
Have you ever worked for this company? * Required
- Yes
- No
If so, when? * Required
Have you ever been convicted of a felony? * Required
- Yes
- No
If yes, explain * Required
Please list the names of any friends or relatives who work for this company:
Please list the names of any relatives living at PCCA:
Education

High School Information:
High School * Required
Address * Required
From * Required
To * Required
Did you graduate? * Required
- Yes
- No
Degree
- Diploma
- GED
Certifications: (please list if applicable)
College Information:
College
Address
From
To
Did you graduate?
- Yes
- No
Degree:
Additional College (if applicable)
Address
From
To
Did you graduate?
- Yes
- No
Degree:
Military Service
Branch
From
To
Previous Employment

First Employer
Company * Required
Phone * Required
Address * Required
Supervisor * Required
Job Title * Required
Time * Required
- Full Time
- Part Time
Starting Salary
Ending Salary * Required
Responsibilities * Required
From * Required
To * Required
Reason for Leaving * Required
Are you eligible for rehire? * Required
- Yes
- No
Second Employer
Company
Phone
Address
Supervisor
Job Title
Time
- Full Time
- Part Time
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
Are you eligible for rehire?
- Yes
- No
Third Employer
Company
Phone
Address
Supervisor
Job Title
Time
- Full Time
- Part Time
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
Are you eligible for rehire?
- Yes
- No
What are your top three reasons for applying for this job? * Required
What past employment, volunteer work, or life experience have you had that prepared you for this position? * Required
How did you learn about Pediatric Complex Care of Arkansas? * Required
Newspaper:
Disclaimer

The information provided in this application for employment is true, correct and complete. If employed, any misstatement or omission of fact on this application may result in dismissal.

In consideration of my employment, I agree to conform to the rules and regulations of Pediatric Complex Care of Arkansas and further agree that my employment and compensation are at the will of PCCA and can be terminated with or without cause and with or without notice, at any time, at the option of either myself or PCCA. I understand and agree that these terms can be modified by the Administrator. No supervisor, representative, agent, or employee of PCCA has now or has had in the past any authority to enter into any agreement of employment for any specific period of time, or to make any agreement which is contrary to or modification of the above terms, nor can any policies or practices of PCCA either written or oral, modify the above terms.

Should the information obtained from Arkansas Child Abuse and Neglect Registry, State or Federal background check contain documentation of substantiated abuse or neglect of a minor, or any of the 61 offenses listed by the Office of Long Term Care as prohibited by an employee, I understand my employment with Pediatric Complex Care of Arkansas will be immediately terminated.

I hereby authorize all educational institutions which I have attended, all branches of U.S. military service in which I have served, all of my former and current employers, and all of their representatives to furnish to Pediatric Complex Care of Arkansas or its representatives any and all information concerning my education, military services, and/or former/current employment. In addition, I hereby agree to hold harmless and to release all of said educational institutions, military services, employers and representatives from any and all claims that I may have, or which may arise against any and/or all of them, including Pediatric Complex Care of Arkansas, as a result of their furnishing information to Pediatric Complex Care of Arkansas.
Applicant Signature * Required

Please type your full name here to e-sign this form.
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See our latest job openings.

Currently, we employ over 100 people who are energetic, nurturing, and dedicated (and really like to have fun). Maybe you could be one of them.

Nursing Aide

North Little Rock, AR

3 years ago

Nursing Aides perform direct care duties for residents (i.e. bathing, grooming, feeding, toileting, etc.), and may also provide nutritional support to children with specialized feeding needs and work with nurses to coordinate care for children.

Learn more Apply Now

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Services Admissions Employment About Contact

4100 Heritage Drive
North Little Rock, AR 72117 Monday-Friday: 8:00am-4:30pm

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