Click the Upload Resume to use your resume to pre-fill this application form.
Email Registration
Your email address will be used as your login name allowing you to return to our website to update your profile.
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RN Degree Level:
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Associate's in Nursing
Bachelor's in Nursing
Master's in Nursing
Not Applicable
Personal Information
Please type your legal name below. Use proper case when entering your name (i.e. John W. Smith).
First Name: *
Last Name: *
Middle:
Please list other names used in order to check past employment and education records.
Other Names Used:
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Current Address:
Street Address: *
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How did you hear about us?
Source: *
--None--
Careers Page
Employee Referral
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I am a current MarinHealth employee
Indeed
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Recruiter Contacted Me
UCSF Health Referral
Referred By (Name):
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Additional Information
Salary Expectations: *
Salary Expectations Term: *
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Annual
Hourly
Current Employee?
Internal Applicants
Relatives Employed: *
Employee ID Number:
Previous Employee: *
Please select
Yes
No
Are you legally authorized to work in the United States?
Authorized to Work: *
Please select
Yes
No
Are you at least eighteen (18) years of age?
18+: *
Please select
Yes
No
Are there any current restrictions on your professional license or restrictions on your right to practice, including any pending proceeding before a licensing agency that could affect your ability to work and/or practice your profession?
If yes, please explain.
License Restrictions:
Please select
Yes
No
License Restrictions Details:
Attachments
Please attach an updated resume.
* Not including a resume may cause delay in the recruitment process.
Your resume can be uploaded in any of the following formats: DOC, DOCX, RTF, PDF, TXT, HTML. (If you have already uploaded your resume at the beginning of the application using the pre-fill function you do not need to re-attach it here.)
Attach Resume:
Additional Information
You can use the text area for any supplementary information you would like to provide about your career goals, availability, best times to contact you, etc.
Cover Letter:
Employment History (Beginning with your current or most recent employer, please account for all of your employment during the past ten years including jobs, volunteer work, self-employment, military service, etc. You must specify 1 work experience entry. If you worked for an agency (e.g., Spherion, Nurse Finders), enter the agency name as your employer and complete the remaining information about your employment with that agency.):
Education - Please begin by listing your educational experiences below, starting with the most relevant. You may continue adding educational experiences until you have entered all that are relevant.:
Certificates/Licenses - Please begin by entering the most relevant certification or licensure you have received. You may continue adding certifications and licensures until you have entered all that are relevant. Do not list expired certifications or licensures.:
References - Please list your professional references below in the order of contact preference, starting with the most relevant. Professional references are individuals that are familiar with your work capabilities and your educational background.:
Background Check and/or Public Records Search:
Have you ever been convicted of a crime?
If the above answer is yes, please indicate date, conviction, court name, city, and county of offense.
Conviction Disclosure: *
Please select
Yes
No
Conviction Details:
The term “conviction” includes a plea, verdict or finding of guilt regardless of whether sentence is imposed by the court. (Cal. Labor Code sec. 432.7) The term “conviction” does not include participation in any pretrial or post-trial diversion plan or a “conviction” that has been sealed, expunged, or eradicated. (Cal. Labor Code sec. 432.7, California Department of Fair Employment and Housing Pre-Employment Inquiry Guidelines; title 2 California Code of Regulations sec. 7287.4.)
The term “crime” means felonies or misdemeanors but does not include minor traffic infractions and marijuana convictions that are more than two years old. (Cal. Labor Code sec. 432.8.)
*Existence of convictions will not necessarily disqualify an applicant from employment; however, failure to fully disclose requested information may be considered falsification and will result in an offer of employment being rescinded or may result in termination of employment upon discovery at any time during employment.
Are you currently on bail concerning an arrest or have you been released on your own recognizance concerning a criminal case currently pending trial?
Pending Trial: *
Please select
Yes
No
Pending Trial Details:
If the position you applied for is in a Health Facility (visiting nurse assoc and medical foundations are not considered Healthcare Facilities) and has access to drugs and medications, have you ever been arrested for an offense involving controlled substances?
Controlled Substance Arrest: *
Please select
Yes
No
Controlled Substance Details:
If the position you applied for is in a Health Facility (a visiting nurse assoc and medical foundations are not considered Healthcare Facilities) and has regular access to patients, have you ever been arrested for a sex offense for which registration as a sex offender would be required upon conviction?
Sex Offense Conviction: *
Please select
Yes
No
Service Excellence
Applicant's Statement:
Reference Check and Release of Information
By clicking "I Agree" below:
I authorize MarinHealth to investigate my references, work record, education and any matter related to my suitability for employment, including contacting persons, who may have knowledge of my job performance, not identified as a reference or supervisor.
I release MarinHealth , my former employers, and all other individuals or entities, from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I authorize MarinHealth to provide a copy of this authorization signed by me to any person or entity contacted regarding my suitability for employment.
I authorize MarinHealth , if contacted by a prospective employer, with regard to my suitability for employment to disclose all documents, reports and other information related to my work records, without giving me prior notice of the disclosure.
Post Offer Pre-Employment Conditions
By clicking "I Agree" below:
I understand that, if required by MarinHealth , employment is conditioned upon successful completion of: a criminal background investigation (including, but not limited to, a social security search, employment verification and criminal records search); a pre-employment drug test and a post-offer medical assessment.
MarinHealth requires a limited medical assessment. This initial exam will be provided to you at no charge. Your exam will include an assessment according to the standard procedures of MarinHealth , as needed, based on pre-employment requirements, the physical requirements and essential functions of the position you are being offered, and the degree of patient contact.
Employment Eligibility Verification
By clicking "I Agree" below:
I certify that I am eligible to work in the United States. All offers of employment by MarinHealth are conditioned on the provision of satisfactory proof of your identity and legal authority to work in the United States. Prior to your first day of employment, you must comply with the requirements of the Immigration and Naturalization Service's Employment Eligibility Verification (Form I-9).
At-Will Employment
By clicking "I Agree" below:
I acknowledge that employment with MarinHealth is "at-will" which means either my employer or myself may end the relationship at any time and for any reason, with or without notice and that this application does not bind either me or the employer for any specific period regarding employment. Please note that the "at-will" employment relationship cannot be modified except in a written document signed by the Chief Executive Officer or his or her designee.
Application Fraud & Misrepresentation or Omission
By clicking "I Agree" below:
I certify that all information provided on this application form and all other information provided by me in the course of applying for employment with MarinHealth is truthful, complete and accurate.
Please note that if any information provided by you on this or any other application is false, untruthful, omitted or misleading, your application may be rejected. In addition, please note that, upon being hired as an employee of MarinHealth or at anytime thereafter, you may be subject to disciplinary action, up to and including immediate termination of employment, if it is discovered that any information provided by you in the course of applying for or accepting employment with MarinHealth is later found to be false, untruthful, or misleading.
I Agree *
Date of Application: Format: M/D/YY *
Initials: *
Voluntary Equal Opportunity Questionnaire
As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.
Gender: *
Please select
Female
Male
Choose Not to Disclose
Race: *
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Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaska Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)
Choose Not to Disclose
Veteran/Disability: *
None
Disabled Veterans
Other Protected Veterans
Armed Forces Service Medal Veterans
Recently Separated Veterans
Choose Not to Disclose