Application form



Experience, Knowledge and Skill

Experience in a supervisory position in nursing services in which executive ability has been demonstrated is required. Experience in a Critical Access Hospital is preferred. Experience working with local, state, and federal regulatory bodies, such as LDH and CMS, is preferred.

Specialized or Technical Education Required

The Chief Nursing Officer will be a graduate of an accredited school of nursing and possess current registration with the Louisiana State Board of Nursing.  A Bachelors Degree, Masters Degree or national certification as a Nurse Administrator is preferred. Understanding of Critical Access Hospital Conditions of Participation is preferred.

Manual or Physical Skill Required


Physical Efforts Required

Strength: Sedentary; Push: Occasionally; Pull: Occasionally; Carry: Occasionally; Lift: Occasionally; Sit: Frequently; Stand: Occasionally; Walk: Frequently


Personal Information

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Referral Information

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Placement Information

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High School

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Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

Previous Employer 1

Previous Employer 2


*All below fields are required.

Reference 1

Reference 2

Reference 3

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