Nurse Information

Touchstone Communities Candidate

Profile

Dyer Christina - NUR-18-00657 - Licensed Vocational Nurse (LVN) - Del Rio, TX 01 AB: 3686 Date Created: 4/10/2018 4:48 PM Page 1 of 5 EOE Statement

We are an Equal Opportunity Employer. We will consider applicants for this position without regard to any category protected by applicable federal, state or local law, including but not limited to: race, color, religion, sex, national origin, age, physical or mental disability, genetic information, veteran status or uniformed servicemember status.

If hired, I understand my employment is at-will as permitted under applicable state law. I understand this means that either the company or I may terminate the employment relationship at any time, for any reason, with or without notice or cause.

Personal Information

Candidate: Dyer, Christina Date Created: 04/10/2018 4:48:11 PM Social Security: Date of Application: 04/10/2018 4:47:19 PM Position: NUR-18-00657 - Licensed Vocational

Nurse (LVN)

Application Method: Mobile

Location: Del Rio, TX Referral Source: Internet/Job Board, indeed Main Phone: 830-***-**** Alternate Phone:

Address: 916 us hwy 87 east, Smiley, TX 78159

Email Address: **************@*****.***

Core Questions

Please enter the name of the specific source where you learned about this position: indeed

Are you legally authorized to work in the United States? I am authorized to work in this country for any employer Why do you want to work for us? If not applicable you must enter "N/A". I am interested in working with your company because I would like to expand my nursing skills My Highest Education Level is...

Other

Education

Institution: Institution Type:

Location: Start Date: Completion Date:

Degree: Overall GPA:

Major:

Notes:

Employment History

Employer: Regency Manor Nursing & Rehabilitation, Floresville, TX - Floresville - TX US Job Title: Charge Nurse LPN

Duties:

I perform all the duties of a charge nurse such as passing medication, charting on residents, communicating with doctors, other nurse, supervising cna, performing accu checks and administating insulin when need, for Touchstone Communities Candidate

Profile

Dyer Christina - NUR-18-00657 - Licensed Vocational Nurse (LVN) - Del Rio, TX 01 AB: 3686 Date Created: 4/10/2018 4:48 PM Page 2 of 5 Employment History continued...

change in condition and perform IV medication and care, performing gtube care and medication Reason for Leaving:

Dates of Employment: From: 02/01/2016 To: 06/01/2017 Rate of Pay: Supervisor:

May we contact? No

Employer: Windsor Nursing and Rehab Center, Seguin, TX - Seguin - TX US Job Title: Charge Nurse LPN

Duties:

I perform all the duties of a charge nurse such as passing medication, charting on residents, communicating with doctors, other nurse, supervising cna, performing accu checks and administating insulin when need, for change in condition and perform IV medication and care, performing gtube care and medication. Reason for Leaving:

Dates of Employment: From: 01/01/2006 To: 03/01/2016 Rate of Pay: Supervisor:

May we contact? No

Employer: Cuero Nursing and Rehabilitation Center, Cuero, TX - Cuero - TX US Job Title: Charge Nurse LPN

Duties:

I perform all the duties of a charge nurse

Reason for Leaving:

Dates of Employment: From: 01/01/2005 To: 03/01/2006 Rate of Pay: Supervisor:

May we contact? No

US Military Experience

Branch of Service:

Rank at Discharge: Years in Service:

Highest Rank Attained: Are you currently

in the reserves?

Additional Information:

Skills Experience

Skill:

Last Used: Skill Level: Education Only Years of Experience: Skill Summary: CPR

2017-07 - 2019-09

Skill:

Last Used: Skill Level: Years of Experience:

Skill Summary:

Skill:

Touchstone Communities Candidate

Profile

Dyer Christina - NUR-18-00657 - Licensed Vocational Nurse (LVN) - Del Rio, TX 01 AB: 3686 Date Created: 4/10/2018 4:48 PM Page 3 of 5 Skills Experience continued...

Last Used: Skill Level: Years of Experience:

Skill Summary:

Licenses and Certifications

Certification Type: Registration Number:

Geographic Area: Certification Date:

Additional:

Certification Type: Registration Number:

Geographic Area: Certification Date:

Additional:

Certification Type: Registration Number:

Geographic Area: Certification Date:

Additional:

Work Schedule

Day Hours Available for Work

Criminal History

Have you been convicted of a crime? Unspecified

Agency:

Type of Crime:

Disposition:

Date Involved: County:

Explanation:

Agency:

Type of Crime:

Disposition:

Date Involved: County:

Explanation:

Agency:

Type of Crime:

Touchstone Communities Candidate

Profile

Dyer Christina - NUR-18-00657 - Licensed Vocational Nurse (LVN) - Del Rio, TX 01 AB: 3686 Date Created: 4/10/2018 4:48 PM Page 4 of 5 Criminal History continued...

Disposition:

Date Involved: County:

Explanation:

Additional Information

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Please read carefully before signing

Touchstone Communities retains the right to verify all information provided by me. In the process of such verification, I fully authorize Touchstone Communities to contact any person, school, organization, or employer listed to disclose all information necessary to verify information or statements. I release all persons who disclose such information from any liability or damages to me or anyone acting in my name. I waive any written notice of the release of such information that may be required by any state or federal law. Any falsification, misrepresentation, or omission, whenever discovered, shall be considered legitimate and sufficient grounds for dismissal. If hired, my employment with Touchstone Communities is at-will. This means that I may terminate my employment at any time. Similarly, the company may terminate my employment at any time, with or without cause. Print Name:

Signature: Date:

References

Name: Personal Reference?

Organization: Title:

Phone: Email:

Address:

Name: Personal Reference?

Organization: Title:

Phone: Email:

Address:

Name: Personal Reference?

Organization: Title:

Phone: Email:

Address:

Touchstone Communities Candidate

Profile

Dyer Christina - NUR-18-00657 - Licensed Vocational Nurse (LVN) - Del Rio, TX 01 AB: 3686 Date Created: 4/10/2018 4:48 PM Page 5 of 5 Please read carefully before signing

I certify that the facts set forth in the employment application and accompanying application materials are true and complete to the best of my knowledge.

Print Name:

Signature: Date:

Please read carefully before signing

This is to inform you that as a part of our procedure for processing your employment application, we may obtain a consumer report and/or an investigative consumer report which includes information as to your character, general reputation, personal characteristics and mode of living. If an investigative report is requested, you have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation. By agreeing below, you acknowledge receipt of a copy of the foregoing notice. A Summary of Your Rights Under the Fair Credit Reporting Act can be viewed at: FCRA Summary of Rights.pdf For New York applicants only, click link to view a copy of Article 23-A of New York Correction Law Print Name:

Signature: Date:

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