Nash Gernal Hospital
Employment Application
Applicant Information
Full Name:
Date:
Worthington
Jannah
S
4/11/98
Address:
2942 RiverLake Rd.
Cary NC 27207
Phone:
(919)234-2711
Email
Jannah.W98@hotmail.com
Date Available:
Social Security No.:
122-34-5493
Desired Salary: $247,569
Position Applied for:
Medical Examiner
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the
U.S.?
YES
NO
Have you ever worked for this
company?
YES
NO
If yes, when?
Have you ever been convicted of a
felony?
YES
NO
If yes, explain:
Education
High School:
Wake Early College of
Health and Science Address: 2901 Holston Lane , Raleigh, NC 27610
From: 2013 To: 2018 Did you graduate?
YES
NO
Diploma:: High School
College:
University of North Carolina at
Chapel Hill
Address:
101 Manning Dr, Chapel Hill, NC, United States
From:
2018
To:
2020
Did you graduate?
YES
NO
Degree:
Bachelor of Science
Other: Medical School Address: 101 Manning Dr, Chapel Hill, NC, United States
From:
2020
To:
2024
Did you graduate?
YES
NO
Degree:
Medical Degree
References
Please list three professional references.
Full Name:
Nuessel Ford
Relationship:
co-worker
Company:
WakeMed Health and Hospitals
Phone:
(919)585-3542
Address:
3234 New Bern Avenue
Full Name:
Cole Mickon
Relationship:
supervisor
Company:
Nash HealthCare Systems
Phone:
(919)872-2732
Address: 2460 Curtis Ellis Dr, Rocky Mt, NC 27804
Full Name: James Fracasso Relationship: Teacher
Company:
University of North Carolina at Chapel Hill
Phone:
(919)435-4579
Address:
101 Manning Dr, Chapel Hill, NC, United States
Previous Employment
Company:
Nash General Hospital
Phone:
(919)872-2732
Address: 2460 Curtis Ellis Dr, Rocky Mt, NC 27804 Supervisor:
Cole Mickon
Job Title:
Phlebotomy Tech
Starting Salary: $11.00 Ending Salary: $14.16
Responsibilities:
complete lab draws, urinalysis, bladder scans, various specimen collection
From: June 2018 To: June 2020 Reason for Leaving:
Medical School and further
training
May we contact your previous supervisor for a
reference?
YES
NO
Company:
SBI
Phone:
(919)383-3353
Address: 3320 Garner Rd, Raleigh, NC 27610 Supervisor: McCloud
Job Title: Forensic Assistant Starting Salary: $51,000 Ending Salary: $55,000
Responsibilities:
Collecting specimens from victims at crime scenes / crime scene analysis
From:
June 2020
To:
June 2024
Reason for Leaving:
Completion of Medical School
May we contact your previous supervisor for a
reference?
YES
NO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $ Ending Salary: $
Responsibilities:
From:
To: Reason for Leaving:
May we contact your previous supervisor for a
reference?
YES
NO
Military Service
Branch:
From: To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application
or interview may result in my release.
Signature: Jannah Worthington Date:
5/4/2028
