Employment ApplicationCareersCareer FairsHiring EventsNursing GraduatesScholarships and Tuition ReimbursementQualities of a Littauer EmployeeBenefitsEmployment ApplicationNathan Littauer Hospital, Nursing Home and network of nine outpatient primary and specialty care centers serve a tri-county area of over 100,000 people. We are the second largest employer in Fulton County with over 960 dedicated employees.SUBMIT ONLY ONE APPLICATION PER YEAR If you wish to be considered for additional positions after submission call us.Are you a current employee of NLH?* Yes NoThis application is intended for new applicants. To express your interest in a position please fill out a bid form located outside of HR. If you have additional questions or concerns please speak directly with a member of the HR Team.Personal InformationName* First Name Middle Name or Initial Last Name Other Names By Which You Have Been KnownAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Telephone Number*Alternate NumberPlease note: All candidates must be eligible for employment in the United States and maintain this eligibility throughout their employment with Nathan Littauer Hospital and Nursing Home. Employment is contingent upon the provision of proof of the right to accept employment in the United States.* I understandAre You 18 Years or Older?* Yes NoCan you provide a work permit? (working papers)* Yes NoAccording to New York State, If you are aged 14-17 you will need an employment certificate, also called "working papers," in order to hold a job in New York State. This rule covers: High school graduates, minors who work for their parents, those who work in farming, or a family-run business.Do you have a legal right to work in the U.S.?*You will be required to furnish proof of lawful work status if you are extended a job offer. Yes NoWill you now, or in the future, require sponsorship for employment visa status (e.g. for an H-1B Visa)?* Yes NoNote: Not all employment opportunities offer H-1B Visa Sponsorship.How did you hear about this position?* Call or walk-in Friend NLH website Indeed Monster.com Social media OtherHiddenName of website?*HiddenNewspaper name*Have you ever been employed by NLH prior?* Yes NoPlease indicate the title of your position and the department you worked in.Ex.) John Smith - Nutritional ServicesWhat was your last name when you were employed here previously?*What was your job title when you were employed here previously?*What were your dates of employment when you were employed here previously?*Why did you leave NLH?*Were you referred by a current Nathan Littauer staff member? Yes NoPlease list their nameAre you related to any current Nathan Littauer staff member? Yes NoPlease list their name and their relationship to youEmployment DesiredPosition or type of work applying for*If nursing, desired unitSeeking:*Please check all that apply. Full Time Part Time Per Diem (8hrs/week) Casual (as needed) Day Evening NightLocation*Please check all that apply. Hospital Nursing Home Primary Care CentersHours per week desiredHiddenRate of pay desired ($/hr)Specify days willing to work if needed (all that apply)* Mon Tues Wed Thurs Fri Sat SunAre you willing to work if needed:Holidays?* Yes NoWeekends?* Yes NoEvenings?* Yes NoNights?* Yes NoEmployment HistoryStarting with the most recent job, list all employers for the last 10 years, noting any gaps in employment under “special skills/additional information” section. Must be completed in full, do not list “see resume”.Begin listing employment history* Start N/A No employment historyEmployer 1Name of employer*Full address*Position title*Supervisor & phone*Dates employed*month/year – month/yearIf present employer, may we contact them?* Yes NoStatus* Full Time Part Time Per Diem CasualHiddenLast rate of pay*Reason for leaving*Describe your principle duties or responsibilities:*Employer 2 Add another employerEmployer 2Name of employer*Full address*Position title*Supervisor & phone*Dates employed*month/year – month/yearIf present employer, may we contact them?* Yes NoStatus* Full Time Part Time Per Diem CasualHiddenLast rate of pay*Reason for leaving*Describe your principle duties or responsibilities:*Employer 3 Add another employerEmployer 3Name of employer*Full address*Position title*Supervisor & phone*Dates employed*month/year – month/yearIf present employer, may we contact them?* Yes NoStatus* Full Time Part Time Per Diem CasualHiddenLast rate of pay*Reason for leaving*Describe your principle duties or responsibilities:*Employer 4 Add another employerEmployer 4Name of employer*Full address*Position title*Supervisor & phone*Dates employed*month/year – month/yearIf present employer, may we contact them?* Yes NoStatus* Full Time Part Time Per Diem CasualHiddenLast rate of pay*Reason for leaving*Describe your principle duties or responsibilities:*Criminal / Professional Misconduct HistoryPlease note: A conviction or finding is not an absolute bar to employment; but will be considered in relation to specific job requirements.Have you ever been convicted of a crime?* Yes NoPlease state the crime, when and where convicted and disposition of the case.*Has the office of professional discipline of the NYS Education Dept or the professional licensing board of another state ever made a finding of professional misconduct against you, or entered into a settlement agreement with you?* Yes NoGive details including when, where, and disposition of the finding.*EducationHigh school name and address*Did you graduate high school?* Yes No GEDLevel(s) of education experience*Check all that apply: Vocation/trade school (completed or partial) Associate’s degree (completed or partial) Bachelor’s degree (completed or partial) Master’s degree (completed or partial) Other None of the aboveVocation/trade school name and address*Vocation/trade school course of study and list degree diploma (if graduated)*Associate’s degree school name and address*Associate’s degree course of study and list degree diploma (if graduated)*Bachelor’s degree school name and address*Bachelor’s degree course of study and list degree diploma (if graduated)*Master’s degree school name and address*Master’s degree course of study and list degree diploma (if graduated)*Other school name and address*Other school course of study and list degree diploma (if graduated)*List any courses or training completed outside of the above degreed programs that would be relevant for the position soughtProfessional Licensure, Registry, Certification, or Drivers LicenseCopy required upon employment. Drivers license only if applying for a driving position.Are you applying for a position that requires a professional license, certification, or a driver’s license?* Yes NoAre you currently registered, licensed or certified?* Yes NoIf not currently registered, licensed or certified, are you eligible?* Yes NoWhen will you/did you sit for your exam?* MM slash DD slash YYYY Primary license or certificationType of professional license/registry/certification*Issuing State or Organization*Number*Expiration date* MM slash DD slash YYYY Additional license or certification, if applicableType of professional license/registry/certificationIssuing State or OrganizationNumberExpiration date MM slash DD slash YYYY Special Skills and Additional InformationPlease list any special skills that you possess and any additional information that you think would be applicable; i.e., volunteer work, membership in professional organizations, computer experience, or outside interests, etc. Also list explanation for any gaps in employment.Exclude any information, which would denote race, sex, marital status, age, national origin, religion or political affiliations.Résumé uploadAccepted file types: doc, docx, pdf, Max. file size: 10 MB.Attach your resume. MS Word and PDF format accepted.Applicant’s Certification and AgreementPLEASE READ CAREFULLY: Equal Opportunity Employment Policy: Nathan Littauer Hospital and Nursing Home provides equal employment opportunity to all its employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation or marital status in accordance with applicable federal and state laws.CERTIFICATIONS I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time except for any reason as prohibited by applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the CEO of this organization. I understand that this application is not a contract of employment.I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof within the first three days of employment will result in termination of employment.I also understand that any handbooks, manuals, policies and procedures maintained by Nathan Littauer are not contractual in nature and may be amended or abolished at the sole discretion of Nathan Littauer. I also understand that as a condition of employment that NLH reserves the right to use employee photo’s/video’s for promotional purposes or for use on social media. I further acknowledge that I will be photograph for my employee ID and must wear ID badge during working hours.I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms therein, except my current employer if so noted, to provide any information requested about me, and I release them and Nathan Littauer from all liability for damage in providing and requesting this information.I understand that as a condition of my employment, I will be required to submit to the following: post-offer pre-employment physical, assessment and drug screen, criminal background check; and based on position may be required to submit to the following in addition to items previously stated: Fingerprint check, DMV check and/or credit check. I understand this application will be active for a period of one year; after that time; if I wish to be considered for employment, I must submit a new application. I certify that all the statements on this application, on related papers or in interviews, are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.I have read the above certification and agreement* YesCommentsThis field is for validation purposes and should be left unchanged.Δ
