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Gordon Rosalita H - NUR-**-***52 - Registered Nurse - MedExpress - Ledgewood 05

Date Created: 10/7/2014 8:41 PM Page 1 of 6

Personal Information

Candidate: Gordon, Rosalita H Date Created: 10/07/2014 8:41 PM Social Security: Date of Application: 10/07/2014 8:30 PM Position: NUR-14-00252 - Registered Nurse Application Method: Web Location: MedExpress - Ledgewood Referral Source: Internet/Job Board, Internet/Job Board, Glassdoor

Main Phone: 973-***-**** Alternate Phone: 201-***-**** Address: 149 Patriots Road, Morris Plains, NJ 07950 Email Address: acz48x@r.postjobfree.com Date of Birth: Core Questions

Please enter the name of the specific source where you learned about this position: Internet/Job Board, Glassdoor

Are you at least 18 years of age or older?

Yes

Are you legally allowed to work in the United States? Yes

Do you now, or will you in the future, need sponsorship from an employer in order to obtain, extend or renew your authorization to work in the US?

No

What is your highest level of completed education? Master''s Degree

Please list any language, other than English, in which you are conversationally proficient. Tagalog, some Spanish

Have you previously worked for or been offered a position with MedExpress? No

If no, please type N/A. If yes, when and where?

N/A

If no, please write N/A. If yes, please provide dates and details. N/A

How many years of relevent clinical nursing experience do you possess? 5+ years

In the last five years, how many of those have you been involved direct patient care? 5

Have you ever been excluded or debarred from federal programs? No

Employment at MedExpress is conditional upon the successful completion of background screenings of your criminal, credit, and employment histories, prior to employment and periodically thereafter. If offered a position, do you authorize MedExpress to complete these screenings?

Yes

Are you currently licensed to practice registered nurse duties in the state of the opening for which you are applying? Candidate

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Gordon Rosalita H - NUR-14-00252 - Registered Nurse - MedExpress - Ledgewood 05 Date Created: 10/7/2014 8:41 PM Page 2 of 6

Core Questions continued...

Yes

Do you meet all requirements to maintain active licensure in the state to which you are applying? Yes

Are you able to physically complete the tasks necessary for this position with or without accommodation? Yes

Skills Experience

Skill: IV certified, BLS,ACLS,EKG monitor

Last Used: 6/01/2014 Skill Level: Advanced Years of Experience: 20 Skill Summary: able to start IV's, Monito patients, render direct patient care Skill: Profecient in Blood draws and IV therapy

Last Used: 6/01/2014 Skill Level: Advanced Years of Experience: 20 years Skill Summary: Able to start IV's as well as draw blood and obtain specimens. Skill:

Last Used: Skill Level: Years of Experience:

Skill Summary:

Licenses and Certifications

Certification Type: NJ RN Registration Number: 26NOO3617500 Geographic Area: New Jersey Certification Date: 05/01/2014 Additional: Active NJ RN license valid 05/31/2015

Certification Type: Registration Number:

Geographic Area: Certification Date:

Additional:

Certification Type: Registration Number:

Geographic Area: Certification Date:

Additional:

US Military Experience

Branch of Service:

Rank at Discharge: Years in Service:

Highest Rank Attained: Are you currently

in the reserves?

Additional Information:

Please read carefully before signing

MedExpress retains the right to verify all information provided by me. In the process of such verification, I fully authorize MedExpress 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 Candidate

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Gordon Rosalita H - NUR-14-00252 - Registered Nurse - MedExpress - Ledgewood 05 Date Created: 10/7/2014 8:41 PM Page 3 of 6

continued...

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 MedExpress 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 unless I am employed under a written agreement that provides for a term different than at-will. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. Print Name: Rosalita H Gordon

eSignature: Date: 10/07/2014

Please read carefully before signing

In the event that I am employed, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge of employment.

Print Name: Rosalita H Gordon

Signature: Electronic Authorization Received - ID: 20264041 Date: 10/7/2014 Candidate

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Gordon Rosalita H - NUR-14-00252 - Registered Nurse - MedExpress - Ledgewood 05 Date Created: 10/7/2014 8:41 PM Page 4 of 6

Please read carefully before signing

FCRA Disclosure and Background Authorization

I. In connection with my application for, and continued employment, I understand that consumer reports and investigative consumer reports may be periodically requested that will include information including, but not limited to, that relating to my character, work habits, performance, experience, reasons for termination of past employment, and Criminal, Administrative, Bankruptcy, and Civil litigation histories.. I understand and agree that as directed by company policy or procedure and consistent with the job described, you may be requesting information from public and private sources about my: workers’ compensation injuries, driving records, court record, education, credentials, credit, and references. I also understand and agree that company policy or procedure may also permit reviewing public information made available on the internet. If company policy requires, I am willing to submit drug testing to detect the use of illegal drugs prior to and during employment.

II. Medical and workers’ compensation information will only be requests in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Consumer Reporting agency. If so, I will be notified and given the name and address of the agency or source that provided the information. III. I acknowledge that a telephonic facsimile (FAX) photographic copy, or electronic shall be as valid as the original. This release is valid for most federal, state and county agencies including the Minnesota Department of Labor. IV. Minnesota, Oklahoma and California applicants only. If you want a copy of the report(s) ordered check this box . The report(s) will be sent by the reposting agency to you at the address below. The report(s) will be processed by: Employment Background Investigations, Inc, P.O. Box 629, Owings Mills, Maryland 21117 or similar vendor. V. I hereby authorize, without reservation, and law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by MedExpress or its agent, to furnish the information described is Section I.

VI. I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer to MedExpress. This release is in accordance with DOT Regulation 49 CFR Part 40, Section 40.25. I understand that information to be release by my previous employer, is limited to the following DOT-regulated items: alcohol tests with a result of 0.04 pr higher, verified positive drug tests, refusals to be tested, other violations of DOT agency drug and alcohol testing regulations, information obtained from previous employers of a drug and alcohol rule violation and any documentation of completion of the return-to-duty process following a rule violation.

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports. Print Name: Rosalita H Gordon

Signature: Electronic Authorization Received - ID: 20264041 Date: 10/7/2014 Work Schedule

Day Hours Available for Work

Sunday not available

Monday not available

Candidate

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Gordon Rosalita H - NUR-14-00252 - Registered Nurse - MedExpress - Ledgewood 05 Date Created: 10/7/2014 8:41 PM Page 5 of 6

Work Schedule continued...

Tuesday 4-8pm

Wednesday 4-8pm

Thursday 4-8pm

Friday not available

Saturday not available

References

Name: Remy Azares Personal Reference? No

Organization: St Clares Hospital Title: APN

Phone: 973-***-**** Email: Remy Azares@saint clares.org Address: 25 Pocono Road, Denville, NJ 07950, USA

Name: Lucy Bouye Personal Reference? No

Organization: Title: Manager

Phone: 973-***-**** Email: acz48x@r.postjobfree.com Address: 69 Fairview Avenue, Verona, New Jersey 07044, United States Name: Resureccion David Personal Reference? Yes

Organization: Job Haines Title: Director of Dietary Phone: 973-***-**** Email: Recy acz48x@r.postjobfree.com

Address: 11 Jones Street, Mine Hill, NJ 07048, USA Previous Names

Name: N/A N/A, N/a

Name:

Name:

Previous Addresses

Address: From: To:

Address: From: To:

Address: From: To:

Drivers License Information

Name: ROSALITA H. GORDON Driver's License #: G65766696800362 Expiration

Date:

06 / 2018 State Issued: NJ

License Type: Operator's License Class:

Endorsements:

Resume

Resume, last updated: 09/29/2014 10:46 PM

Candidate

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Gordon Rosalita H - NUR-14-00252 - Registered Nurse - MedExpress - Ledgewood 05 Date Created: 10/7/2014 8:41 PM Page 6 of 6

Resume continued...

ROSALITA GORDON

149 Patriots Road

Morris Plains, New Jersey 07950

973-***-****

acz48x@r.postjobfree.com

SUMMARY:

HIGHLIGHTS OF QUALIFICATIONS

20 years as Float nurse in the ER, ICU, Maternity, Med/Surg units at Morristown Hosp 2 years as per diem RN at Bayada Home Health

14 years as Assistant Director of Nursing at St. Clare's Hospital, NJ 2 years as supervisor at Holly Manor Nursing Home, Mendham, NJ Assumed charge nurse responsibilities in all nursing departments Excellent interpersonal and customer service skills Performed venipunctures, started IV's and administered IV meds EXPERIENCE:

Holly Manor Nursing Home 1976-1997

Mendham, NJ

Supervisor

Staff Nurse at Morristown Memorial Hospital in ICU, Med/Surg units, ER Maternity, Nursery, L&D, and PACU, then promoted to Supervisor Private Duty Nursing

St Clare's Hospital 1998-2012

Denville, NJ

Assistant Director of Nursing

SKILLS SUMMARY:

nursing, supervisory skills

ADDITIONAL INFO:

CERTIFICATIONS:

Current New Jersey License

BLS

ACLS

PALS

IV THRRAPY

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