Northwest Kidney Centers Employment Application Form

700 Broadway
Seattle, WA 98122
Ph: 206-720-3745
Fax: 206-652-4653
Jobline: 206-720-3747
www.nwkidney.org
HR@nwkidney.org
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POSITION INFORMATION
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  • Auburn Kidney Center
    • Auburn
  • Blagg Pavilion
    • Lake Forest Park
    • Lake City Kidney Center
  • Distribution Center
    • Seattle
  • Lake Washington Kidney Center
    • Bellevue
  • Snoqualimie Ridge Kidney Center
    • Snoqualimie
  • Port Angeles Kidney Center
    • Port Angeles
  • Haviland Pavilion
    • 700 Broadway, Seattle
    • Broadway Kidney Center
  • Elliott Bay Kidney Center
    • 600 Broadway, Seattle
  • Enumclaw Kidney Center
    • Enumclaw
  • Kent Kidney Center
    • Kent
  • Kirkland Kidney Center
    • Kirkland
  • West Seattle Kidney Center
    • West Seattle
  • Hospital Services
  • Seattle Kidney Center
    • 548 15th Ave, Seattle
    • Seattle Kidney Center
    • Home Hemodialysis
    • Peritoneal Dialysis
  • Scribner Kidney Center
    • Northgate
  • SeaTac Kidney Center
    • SeaTac
  • Renton Kidney Center
    • Renton
EDUCATION AND TRAINING
High School / Locations Field of Study
Graduate? Grade Point Average Diploma
College or Other Schools / Locations Dates Attended Field of Study
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to
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Graduate? Grade Point Average Degree / Certificate
College or Other Schools / Locations Dates Attended Field of Study
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to
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Graduate? Grade Point Average Degree / Certificate
College or Other Schools / Locations Dates Attended Field of Study
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to
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Graduate? Grade Point Average Degree / Certificate
PROFESSIONAL REGISTRATION / LICENSE
Type of Registration / License
State Number Date of Expiration
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Type of Registration / License
State Number Date of Expiration
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If you do not have a registration / license, have you applied for one?
If an examination is required, what date are you scheduled to take the examination?
If not licensed in Washington State, have you applied for endorsement?
EMPLOYMENT
Start with your present or most recent job and list ALL employment and work-related activities, including self-employment, military employment and periods of unemployment. Please go back at least 10 years and use additional paper if needed. DO NOT PUT “SEE RESUME”. You may attach a resume if you desire.
You can add up to 4 extra employments as needed.
Company Name – Present or most recent employer
Address
Your Job Title
Duties / Responsibilities (max length: 300 characters)
Reason for leaving or considering a change
Telephone
Supervisor’s Name
Employed – (State month and year)
From
To
Beginning Rate of Pay Ending Rate of Pay
Average hours per week
Employed under what name?
Company Name – Present or most recent employer
Address
Your Job Title
Duties / Responsibilities (max length: 300 characters)
Reason for leaving or considering a change
Telephone
Supervisor’s Name
Employed – (State month and year)
From
To
Beginning Rate of Pay Ending Rate of Pay
Average hours per week
Employed under what name?
Company Name – Present or most recent employer
Address
Your Job Title
Duties / Responsibilities (max length: 300 characters)
Reason for leaving or considering a change
Telephone
Supervisor’s Name
Employed – (State month and year)
From
To
Beginning Rate of Pay Ending Rate of Pay
Average hours per week
Employed under what name?
Company Name – Present or most recent employer
Address
Your Job Title
Duties / Responsibilities (max length: 300 characters)
Reason for leaving or considering a change
Telephone
Supervisor’s Name
Employed – (State month and year)
From
To
Beginning Rate of Pay Ending Rate of Pay
Average hours per week
Employed under what name?
+ ADD ADDITIONAL EMPLOYMENT
PERSONAL INFORMATION
EEO POLICY STATEMENT
Northwest Kidney Centers is committed to an Equal Opportunity program which Provides for the recruitment of all qualified persons without discrimination. To assure Equal Employment Opportunity and for statistical purposes, NKC requests that you provide the following information. Completion of this section is voluntary, and a decision not to provide this information will not result in any adverse treatment of your application for employment. This section will be detached from your application prior to review by Human Resources.

PLEASE READ CAREFULLY BEFORE SIGNING
I certify that all information given in this application is true to the best of my knowledge. I am aware that if employed, incomplete, misleading or falsified information on this application constitute grounds for immediate dismissal.
I understand that my employment is “at will” and my employment and compensation can be terminated at any time, with or without cause and with or without notice, at the option of either the company or myself.
I understand that my employment may be contingent upon proof of eligibility to work in the United States, satisfactory references, and criminal background check.
By signing this Application electronically, you agree your electronic signature is the legal equivalent of your manual signature on this Application.
AUTHORIZATION TO RELEASE EMPLOYMENT RECORDS
I authorize Northwest Kidney Centers to solicit information regarding my character, general reputation, previous employment and similar background information. I release all parties and persons connected with any such information request for information from all claims, liabilities and damages for any reason, which may arise out of the furnishing of such information. If employed, I release Northwest Kidney Centers from any liability for future references it may provide regarding my work history with it.
By signing this Application electronically, you agree your electronic signature is the legal equivalent of your manual signature on this Application.

Mission Statement

To promote optimal health, quality of life, and independence of people with kidney disease, through patient care, education, and research.

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