Employee Application

First and Last Name *

First

Last

Email *

Phone *

Address (Please include City and State) *

What type of position are you looking for? Describe your specialty. *

What is your desired hourly rate range or salary? *

When are you available to start working? Do you need to relocate? *

What type of schedule are you looking for? Choose all that apply. *

What days are you available to work? Choose all that apply. *

What shifts do you prefer? ie. Morning, Day, Night shifts, Any *

Please put desired schedule here.

Your Educational Degree(s) and Certificate(s)? Please list all *

Associate Degree, Bachelor Degree, Masters, PHD, Trade, Certificates, etc.

Why are you seeking a new position? *

Are your BLS, CPR and First Aid certifications current? *

Are you ok with us conducting a Background Check? *

How many years of experience in your field do you have? *

Discuss your professional experience: *

Is there anything about you that sets you apart from other medical employees? *

Are you looking for Paid Sick Days, Vacation Days, Paid Holidays, Medical? Please check all that apply. *

Are you legal to work in the U.S.? *

How did you find us? *

Please list 3 of your most recent references (phone and email): *

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