Application form – Permanent Submit Your Profile For Permanent Please mention NA if it does not apply to you SCREENING QUESTIONS RESPONSES ATTACHMENTS Basic Information Full Legal Name - Along with Middle Name Phone Number (Mobile/Home) Primary Email ID Complete Address Work Authorization (Yes/No) Professional Information/Preferences Are you currently on Assignment? (Yes/No) Is it Full Time/PRN/Per Diem or Contract? Total Relevent experience When are you looking to start? Expected Salary Shift interested in: (Nights/Days/Evenings) Are you open for any other shift apart from mentioned above Shift hours interested in 8/10/12 hours Preferred Time for the phone interview: Highest Patient ratio: Trauma level worked in (I, II, III, IV) EMR Charting system: Equipment/Tools/Machines used (For Lab/Imaging Professionals) Please share recent and updated resume Education Information Highest related Completed Education (Please do not mention the ongoing education) College/University Name (Graduation Month & Year) Certifications and Licenses Active License & Number (State license name) BLS ACLS PALS NRP TNCC/AWHONN/ENPC/Any other speciality Certification CST/Sterile/ARDMS/ARRT/ASCP/CMA /Any other professional Certification Travel Information Local Travel(a. Own Vehicle or b.public transport) Relocate (Can you manage housing expenses)Yes/No
