Career Application

Complete the form below to submit your resume and information. One of our team members will reach out to you regarding your application.

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PJ HealthCare Services Job Application

Personal Data
Emergency Contact Information
Job Information
Position (Job Class) Applying for:
Work Experience/Skills Please list the number of years you have experience in each area (min 1 year exp.) and are clinically competent to work:
Work Experience 1
Work Experience 2
Work Experience 3
Work Experience 4
Previous Facility Types Worked: Check All That Apply
Language Skills: Other than English, please check any other languages you speak –
Check the type of assignment you are available for:
Check the days of the week you are available to work:
Has your professional license ever been suspended, revoked or under investigation?
Certifications: Check all applicable certifications and enter expiration date:
Checkboxes
Checkboxes
Checkboxes
Checkboxes
Checkboxes
Checkboxes
Checkboxes
Work Experience: List all of your work experience beginning with your most recent job. You will be asked to explain all gaps in employment. Attach additional sheet(s) if necessary.
Date:
Pay Rate/Salary:
May We Contact:
Are your employment records listed under another name
Supervisory Experience:
Work Experience 2: List all of your work experience beginning with your most recent job. You will be asked to explain all gaps in employment. Attach additional sheet(s) if necessary.
Date:
Pay Rate/Salary:
May We Contact:
Are your employment records listed under another name
Supervisory Experience:
Additional Information:
1. Are you legally authorized to work in the USA?
2. Have you ever been convicted of a felony?
3. Can you pass a pre-employment drug test?
4. How were you referred to PJ Healthcare Services?
References:
I understand that I must report all accidents to my immediate supervisor and to PJ HealthCare Services - - No MATTER HOW SLIGHT.
I also understand that I must wear all required personal protection equipment (PPE). The penalty for not wearing PPE is disciplinary action, up to and including termination.
ACKNOWLEDGMENT (Please read carefully and sign)

In signing this application, I certify that I have read and fully understand the questions asked in this application and that all answers given by me are true, accurate, and complete. I also understand that the omission, concealment, or misrepresentation of any fact on this application or during any interview for employment may jeopardize my chances for employment and be cause for my immediate dismissal from employment.

I give PJ HealthCare Services permission to use any information in this application to enable it and its agents to verify the information contained in this application I also authorize present and former employers, educational institutions I have attended, credit agencies, all references, and any other persons to answer all questions asked by PJ HealthCare Services with regard to any of the subjects covered by this application. I also understand that in connection with my application for employment or my employment, PJ HealthCare Services may conduct a criminal background investigation and that my employment may be contingent on the results of such investigation. I release PJ HealthCare Services, its agents, and all affiliated entities, as well as any person or situation that provides any information about me, from any and all liability whatsoever resulting from any such investigation or the disclosure of such information. This agency will check the employee misconduct registry (EMR) maintained by DADS. As required by TAC 93.3 and Chapter 253, Texas Health and Safety Code.

In consideration of my employment and of my being considered for employment by PJ HealthCare Services, I agree to abide by all rules and regulations, which I understand are subject to change at any time for any reason without prior notice. I also understand that if employed, I will be an employee at will and employed for no definite period of time. I understand that either PJ HealthCare Services or I can terminate my employment at any time, with or without cause and with or without advance notice. I further understand that no communication, whether oral or written, by any representative of PJ HealthCare Services, at any time, can constitute a contract of employment. No representative or agent of PJ HealthCare Services, has the authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing

I am willing to submit to a physical examination, including the analysis for the detection of the use of unlawful drugs or substances in accordance with the applicable laws. If I receive an offer of employment I agree that my continued employment may be contingent on the results.

I understand that PJ HealthCare Services is not involved in the day-to-day supervision or decision concerning patient care or dentistry. This remains with the Professional as part of the Professional’s practice. The Professional fully indemnifies PJ HealthCare Services against any and all liability and responsibility associated with his or her professional duties. The Professional maintains his or her license as required by law, professional liability coverage and other responsibilities as found under state prime contract law.

I HAVE READ THE ABOVE AND FULLY UNDERSTAND IT.