CG Health Staffing Solutions

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Employment Application

The completion of your application and skills checklist is a required step in the application process.

Although you can still speak with a recruiter about positions, the sooner we receive your application and skills checklist, the sooner you can start enjoying the many benefits and perks that CG Health Staffing has to offer.

Please select your specialty from the list below. You can print the form and fill it out or you can fill it out online and send it. If you choose to print it, you can fax it to 713-774-1302.

print download

CG Health Staffing, LLC Employment Application

Name:

Home Telphone:

Street Address:

City:

State:

Zip:

Mobile Phone :

Beeper/Pager:

E-Mail:

Position Applying:

Other (Specify):

Work History

Current or Last Employer:

Supervisor:

Telephone:

Street Address:

City:

State:

Zip:

Job Title:

Salary:

Dates Worked

From:

To:

Name Used While Employed:

Reason for Leaving:

Duties:

May we contact this employer to obtain reference?
Yes No

Prior Employer:

Supervisor:

Telephone:

Street Address:

City:

State:

Zip:

Job Title:

Salary:

Dates Worked

From :

To:

Name Used While Employed:

Reason for Leaving:

Duties:

Education

Name of High School:

Street Address:

City:

State:

Zip:

Check Highest Grade Completed:

1	2	3	4
5	6	7	8
9	10	11	12

Name of College or Nursing School:

Name Used While Attending:

Degree:

Course:

Certificate:

Street Address:

City:

State:

Zip:

Date Received:

Shift Preferences: (select all that apply)

6:45am - 3:15pm	6:45am-7:15pm
6:00am - 2:00pm	7:00am-3:00pm
7:00am-7:00pm	8:30am-5:00pm
8:00am-4:00pm	8:00am-5:00pm
2:00pm-10:00pm	3:00pm-11:00pm
6:45pm-7:15pm	7:00pm-7:00am
10:00pm-6:00pm	11:00pm-7:00am

How many weekday shifts are you interested in working per week?

How many weekday shifts are you interested in working per month?

How many weekend shifts are you interested in working per week?

How many weekend shifts are you interested in working per month?

Upload Your Resume

Were You Ever Convicted Of A Crime? Yes No

If Yes, Please Explain:

* Criminal conviction (s) will not automatically disqualify an applicant from employment with CG Health Staffing, LLC.

CG Health Staffing

Main Menu

Employment Application

713-774-1300