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Resume
(Please copy & paste in plain-text format)
Job Information
Position applying for:
RN
NP
LP/VN
CNA
CST
ST
Tech
Allied
Diagnostic Imaging
Radiation Therapy
Physical Therapy
Occupational Therapy
Speech Therapy
Pharmacy
Lab
Clerical
Other:
Date Available for Work:
Format: MM / DD / YYYY
Work Experience / Skills
Please list the number of years you have experience in each area (Minimum 6 months) and are clinically competent to work.
Burn
L&D
MICU
NICU
PACU
SICU
CCU
ENT
Rehab
Nursery
Dialysis
Geriatric
Pedi ICU
Med/Surg
Pediatrics
Telemetry
Psychiatry
Stepdown
Oncology
Neurology
Open Heart
Detox/Drug Rehab
Post Partum
Orthopedics
Mother/Baby
Recovery Room
Operating Room
Emergency Room
Other speciality:
Years of experience:
Type of Work Desired
(Check all that apply)
Position applying for:
Hospital
Clinic, specify:
Hospice
Nursing Home
Rehab
Assisted Living/ Residential Treatment
Private Duty
Language Skills
(Check all that apply)
Excluding English, please select other languages you speak.
Spanish
French
German
Other:
Daily Availability
(Check all that apply)
Check the days of the week you are available.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Shift Availability
(Check all that apply)
Check the shift(s) you prefer.
7am - 3pm
3pm - 11pm
11pm - 7am
7am - 7pm
Other: (24-hour format)
-
Education/Training
(Please list all schools attended. Begin with high school then vocational/military and college.)
High School:
Name:
City:
State:
Zip:
Country:
Highest grade completed
College / Vocational:
Name:
City:
State:
Zip:
Country:
Highest grade completed
Major Emphasis:
Degree:
Completed?
Yes
No
Level and Type:
Graduate School:
Name:
City:
State:
Zip:
Country:
Highest grade completed
Major Emphasis:
Degree:
Completed?
Yes
No
Level and Type:
Other
(Please list any other work related information, such as specialized training, certifications, additional work experience, etc.)
References
(Please list three individuals with whom you have worked and were in a position to evaluate your performance.)
Name:
Title:
Address:
Phone: (
)
-
Name:
Title:
Address:
Phone: (
)
-
Name:
Title:
Address:
Phone: (
)
-
Additional Information
Are you legally authorized to work in the USA?
Yes
No
If No, are you interested in being sponsored to work in the USA?
Yes
No
Note: If yes, you must commit to atleast 3 years.
Have you ever been convicted of a felony crime?
Yes
No
Have you ever been employed by EMStaff or any of its
subsidiaries*
?
Yes
No
If yes, give location(s) and date(s):
Have you ever been Interviewed with EMStaff or any of its
subsidiaries*
?
Yes
No
If yes, give location(s) and date(s):
How were you referred to EMStaff?
Newspaper
Trade Publication
Job Fair/Open House
Internet Site
MSN Website
Other Source
*Subsidiaries of
EMStaff
Include
Eurosoft Inc
. and
Eurostaff
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