Position Title: Pediatric Nurse Practitioner-Lafayette, IN. Status: Full-Time

Similar documents
Thank you for your interest in employment with Black Hills Surgical Hospital and Black Hills Urgent Care.

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

AVI Systems, Inc. Employment Application

Equal Employment Opportunity Self-Identification Applicant Survey

Employee EEO Self-Identification Form

Crothall Services Group Environmental Services / Housekeeping

Name: First Middle Initial Last Social Security Number: Current Street Address/Apt #: City: State: Zip Code:

Education and Training

Equal Employment Opportunity Self-Identification Applicant Survey

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT EASTERN SHORE RURAL HEALTH SYSTEM, INC, Market Street, Onancock, VA 23417

2. Use the space bar or the mouse to check the appropriate boxes.

Columbia College Director of Teacher Education and Accreditation


(City) (State) (Zip Code) (Evening) Are you legally authorized to work in the United States? Yes. No If yes, who? EMPLOYMENT DESIRED

Example Application DO NOT SUBMIT

Part Time Student Office Clerk Administrative Services Support Team Job Responsibilities

Applicant Information

CITY OF HOLLY HILL EMPLOYMENT APPLICATION 1065 Ridgewood Avenue Holly Hill, Florida An Equal Opportunity Employer

Title: Date Available:

EMPLOYMENT APPLICATION Part 1. Please answer all questions completely and print legibly.

WAKULLA COUNTY. EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer EDUCATION HIGH SCHOOL: POSITION APPLIED FOR.

16 th Annual Nurse Camp Application Packet Checklist

TEMPORARY LECTURER APPLICATION FOR EMPLOYMENT

Ethnic Minorities and Women s Internship Grant Guidelines

APPLICATION FOR EMPLOYMENT

AMERICAN AMBULANCE SERVICE, INC.

APPLICATION FOR EMPLOYMENT

CODAC BEHAVIORAL HEALTH SERVICES, INC.

Volunteer Application

ALAMEDA COUNTY EMPLOYMENT APPLICATION

Additionally, the parent or legal guardian must provide the following documents upon registration of a new student:

EMPLOYMENT PRE-SCREEN QUESTIONNAIRE

STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH Subsurface Sewage Disposal System INSTALLER License Application

CITY OF NEW BEDFORD APPLICATION FOR EMPLOYMENT PERSONNEL DEPARTMENT 133 WILLIAM STREET, ROOM 212 NEW BEDFORD, MA (508)

New Substitute Paraprofessional or Secretary Fingerprint-Based Criminal Background Check Procedures

~ PARTICIPANT APPLICATION ~

Employment Application

Durham, New Hampshire 03824

EMPLOYMENT PRE-SCREEN QUESTIONNAIRE

COUNTY OF ALBANY MINORITY AND WOMEN-OWNED BUSINESS ENTERPRISE CERTIFICATION APPLICATION

Prequalification Questionnaire Vendor / Contractor/ Consultant

St. Mary s County Health Department

Juvenile Services Officer Application Information

FIRE RECRUIT CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS MINIMUM QUALIFICATIONS

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply.

APPLICATION FOR EMPLOYMENT

OFFICE OF PHYSICAL PLANT

Employment is contingent upon completing a six (6) month probationary period.

APPLICATION FOR EMPLOYMENT

International Transit Studies Program

STATE FISCAL YEAR 2017 ANNUAL NURSING HOME QUESTIONNAIRE (ANHQ) July 1, 2016 through June 30, 2017

Candidates failing to include ALL required documentation will be disqualified.

Application for Employment An Equal Opportunity / Affirmative Action Employer

Deputy Sheriff Trainee (Sponsorship)

WHITMAN COUNTY CIVIL SERVICE COMMISSION

EQUAL EMPLOYMENT OPPORTUNITY DATA FORM Please Return to: City of Geneva Human Resources 22 South First Street Geneva, IL 60134

CENTRAL GEORGIA ELECTRIC MEMBERSHIP CORPORATION EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION

Applications accepted for available positions ONLY

Ben Walsh, Mayor CITY OF SYRACUSE MINORITY AND WOMEN BUSINESS ENTERPRISE CERTIFICATION APPLICATION

CITY OF TWIN FALLS JOB ANNOUNCEMENT

Employment Application

American Foods Group, LLC APPLICATION FOR EMPLOYMENT General Labor and Production Support NOTICE TO APPLICANTS

American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) Analytics Data Dictionary

CITY OF DOVER POLICE DEPARTMENT APPLICATION FOR POLICE OFFICER

St. Vincent Apartments 1521 Las Vegas Blvd. North Las Vegas, NV 89101

pg. 1 AASP Minority Scholarship Application

EMPLOYMENT APPLICATION

DANE COUNTY PUBLIC SAFETY COMMUNICATIONS

Clarkson University Supplemental Application Class of 2021

Name: The Town of East Haven. Application for Employment. Position: Secretary II, Grade Level 10

Application For Employment

Position number. Name (Last, First, MI) City, state, zip. Have you ever been employed by the University? If yes, list department, campus, dates Yes No

Optometry Renewal Application

UNIVERSITY OF NORTH DAKOTA PHYSICIAN ASSISTANT PROGRAM

2019 CTS/MNDOT CIVIL ENGINEERING INTERNSHIP PROGRAM APPLICATION

PO BOX 535 BROOKLYN IA PHONE: FAX: APPLICATION FOR EMPLOYMENT PLEASE PRINT

Optometry Renewal/Reinstatement Application

UNIVERSITY OF CALIFORNIA Kearney Agricultural Center. Application for Employment

INFORMATION CERTIFICATION

CHECK ALL DEPARTMENTS OF INTEREST: CAFETERIA BUS DRIVER PRIME TIME

Home Care Assistants

Licensed Nursing Assistant Renewal/Reinstatement Application

Last Name First Name M.I. Name You Prefer. City State Zip Address. Daytime Phone Evening Phone Best Time to Call. City State If yes, where?

EMPLOYMENT APPLICATION

Employment Application

CALIFORNIA STATE UNIVERSITY, STANISLAUS School Nursing Application to the Pre-licensure Nursing Program

Last Name First Name Middle Initial Today s Date. Desired Shift Day Shift Night Shift

Citrus County Tax Collector s Office Application for Employment

GENERAL APPLICATION FOR EMPLOYMENT

MDwise Marketplace Provider Enrollment Form This form is used in enrolling as a participating provider with the MDwise Marketplace Product

Complete the Attached Addendum

KENTUCKY LIBRARY ASSOCIATION SCHOLARSHIP FOR MINORITY STUDENTS SUBMISSION INFORMATION AND APPLICATION

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168

APPLICATION TO TRADITIONAL RN TO BSN PROGRAM

APPLICATION TO RN TO BSN PROGRAM

Crandall Fire Department

Transcription:

Position Title: Pediatric Nurse Practitioner-Lafayette, IN Status: Full-Time Salary: $85,000.00 to $120,000.00/year Riggs Community Health Center is seeking highly trained, independent Pediatric Nurse Practitioner who enjoys teaching and practicing primary care with a vulnerable population. Riggs CHC is dedicated to the mission of improving access to quality, cost effective, comprehensive health care with respect and compassion to under-served community members. The right candidate will share our mission and will reap the rewards of a fulfilling career in helping our community. Riggs Community Health Center's service area population in Tippecanoe County is low-income amounting to nearly 70,000 low-income individuals of the approximately 192,000 residents. Of these low-income individuals, only 18 percent are being served by community health centers. Tippecanoe County is in west-central Indiana, a mix of urban and rural areas with metropolitan cities, academic communities, rich farmlands and a meandering river. Tippecanoe County is designated as a Medically Under-served Area/Population (MUA/P), as well as a single county low-income and mental Health Professional Shortage Area (HPSA). Riggs CHC has earned excellent scores in primary care (HPSA score of 15), dental (HPSA score of 21), and a mental health (HPSA score of 20). *No Call - CME - Competitive Benefits - Incentive Bonus - Education Reimbursement* Clinic Hours: Monday - Friday 8:00am - 5:00pm NPs work independently and in collaboration with physicians and other health care professionals. NPs provide primary health care to individuals and families, emphasizing health promotion and disease prevention. NPs assess and manage common acute and chronic illnesses. NPs consult and make referrals to physicians and other health care members of the health care team as appropriate. Provision of care includes, but is not limited to, comprehensive assessment, ordering, conducting and interpreting diagnostic tests, prescription of pharmacological agents and treatments, and nonpharmacological therapies. Teaching and counseling individuals, families, and groups are a major part of NP activities. Education & Qualifications: Graduate of an accredited school of nursing and nurse practitioner program. Masters in Nursing required. Current Indiana registered nurse license. Certified as a nurse practitioner by an approved certifying organization. Indiana CSRC and DEA certification preferred. CPR certification. Excellent interpersonal skills. Bilingual in Spanish helpful.

Clinical Care Utilizes appropriate and effective patient care plans Manages patients to assure continuity of care Provides whole person care, which includes referrals to other health care providers. Maintains adequate, concise and legible documentation of patient care. Provides and documents appropriate periodic health examinations. Provides appropriate patient education. Demonstrates appropriate work habits which includes: arriving on time, returning phone calls same day, utilizing appropriate infection control measures, documentation in a timely manner, maintaining appropriate patient confidentiality, and making scheduling changes only through the Medical Director.

MISSION STATEMENT Riggs Community Health Center is dedicated to the mission of improving access to quality, cost effective, comprehensive health care with respect and compassion to underserved community members. VALUES R Respect We treat our patients and each other with dignity. I - Integrity and Honesty We are truthful and ethical in our daily actions. G Generosity We provide services to others in need, with kindness and compassion. G - Guaranteed Quality We strive for improvements and desire healthy outcomes in our patient care. S - Stewardship All resources, including staff, supplies, and funding, are managed responsibly. I understand if an offer of employment is extended that I would be responsible to support and represent these values and the mission of Riggs CHC. Signature Printed Name Date

Application for Employment Name: Social Security #: Address: City: State/Zip: Home Phone #: Alternate Phone #: Position Desired: Date you can start: Wage desired: Are you presently employed? No Yes (if yes, where): Do you have any relatives or friends who work for us? No Yes (if yes, who and where they work): Have you ever been employed by us before? No Yes (if yes, please provide dates and supervisor) Are you legally eligible for employment in the United States? No Yes (Proof of identity and legal authority to work in the United States will be required upon employment) How did you hear about us? Advertisement Friend Current Employee Walk in Web Site Other:

EMPLOYMENT HISTORY Include your last three employers (include periods of unemployment, if applicable) and start with the most recent. Name of Present or Last Employer: Address: Your Job Title: Supervisor s Name: Phone No: ( ) From: / / To: / / MM DD YY MM DD YY Duties and Responsibilities: Reason For Leaving: Rate of Pay Name of Next Employer: Address: Your Job Title: Supervisor s Name: Phone No: ( ) From: / / To: / / MM DD YY MM DD YY Duties and Responsibilities: Reason For Leaving: Rate of Pay Name of Next Employer: Address: Your Job Title: Supervisor s Name: Phone No: ( ) From: / / To: / / MM DD YY MM DD YY Duties and Responsibilities: Reason For Leaving: Rate of Pay

Education High School Degree obtained_y / N_ Major/Degree Certification Degree obtained_y / N_ Major/Degree College Degree obtained_y / N_ Major/Degree Skills Please list any other experience, skills, or qualifications which you believe should be considered in evaluating your qualifications for employment. Foreign Languages Please list any foreign language(s) you are able to speak, read, and write fluently: References Please list names and telephone number of three business/work references who are not related to you. If unavailable, list three school/personal references not related to you. Name Company or Organization Telephone # Years Known

I understand and agree that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the Employer s service if I have been employed. I understand that if an offer of employment is extended, it is conditioned upon successful completion of a background investigation and pre-employment drug screen. I give Riggs Community Health Center the right to contact all references and to secure additional information about me, if job related. I hereby release from liability Riggs Community Health Center and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. Riggs Community Health Center is an Equal Opportunity Employer. Riggs Community Health Center does not discriminate in employment and no questions on this application are used for the purpose of limiting or excusing any applicant s consideration for employment on a basis prohibited by local, state, or federal law. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Riggs Community Health Center will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee s Form I-9 to confirm work authorization. If the Government cannot confirm that you are authorized to work, this Riggs Community Health Center is required to provide you written instructions and an opportunity to contact SSA and/or DHS before taking adverse action against you, including terminating your employment. Employers may not use E-Verify to pre-screen job applicants or to re-verify current employees and may not limit or influence the choice of documents presented for use on the Form I-9. In order to determine whether Form I-9 documentation is valid, this employer uses E-Verify s photo screening tool to match the photograph appearing on some permanent resident and employment authorization cards with the official U.S. Citizenship and Immigration Services (USCIS) photograph. If you believe that your employer has violated its responsibilities under this program or has discriminated against you during the verification process based upon your national origin or citizenship status, please call the Office of Special Counsel at 1-800-255-7688 (TDD: 1-800-237-2515). This application is current for 90 days. At the conclusion of this time if I have not heard from Riggs Community Health Center and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that just as I am free to resign at any time, the Riggs Community Health Center reserves the right to terminate my employment at any time, with or without cause and with or without prior notice. I understand that no representative of Riggs Community Health Center has the authority to make any assurances to the contrary. Signature of Applicant Date Rev 11/16

Rev 02/15 AFFIRMATIVE ACTION INFORMATION FORM We are an affirmative action government contractor. In compliance with government regulations we are required to track the number of our applicants by gender, race / ethnicity, and position for which applied. We invite you to indicate your gender and race / ethnicity below. This information will be kept separately from your application and will be used only in accordance with federal and state regulations. YOU ARE NOT REQUIRED TO PROVIDE THIS INFORMATION. Your application for employment will be considered in the same manner whether or not you fill out this form. GENDER Male Female RACE / ETHNIC GROUP White (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or Middle East. Black (Not of Hispanic origin) All persons having origins in any of the black racial groups of Africa Hispanic All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. American Indian or Alaskan Native All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. Other (Please Specify) Name: Position applied for: Date of application: Referred by: How did you learn about the position?