Apply – First RN Staffing

Name *

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Last

Address *

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How did you hear about us? *

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Are you a U.S. citizen? *

Do you have the legal right and necessary papers to work and live in the United States? *

If you are not a citizen, are you prevented from becoming lawfully employed because of visa or immigration status? *

Are you 18 years or older? *

Date of Birth *

Phone *

Cell Phone *

Email *

Confirm Email

Have you ever applied with First RN Staffing? *

If yes, when?

Have you ever worked for First RN Staffing? *

If yes, when?

What position?

Will you be able to attend work regularly and conform to working hours required? *

Name of High School Attended *

Address of High School

Address Line 1

Address Line 2

City

State

Zip Code

Year Graduated *

Name of College Attended *

Number of Years

Did you Graduate? *

Type of Degree Earned? *

Other Training?

Nurse Type *

RN
LPN
CNA
Certified Medical Assistant
Phlebotomist
Health Information Technician
Nurse Practitioner
PT
STNA
Personal Care Tech
Direct Support Professional
PCT
CMT
Behavioral Health Tech
GNA

What is your preferred shift? (check all that apply) *

Days
Nights
Midnights

Years of Experience *

License Number

Date Issued

Date of last physical *

Date of last Mantoux (TB) Test *

Wound Care Certified?

Yes, I am Wound Care Certified

Specialties? *

Hospice
Emergency care
ICU
Urgent care
Trauma care
Critical care
Neonatal and pediatric intensive care
OB
Rehabilitative care
Psychiatric acute care
Acute care surgery
Long term care
Clinics
Doctor's office
School nursing
Occupational health
Case management

Suspended License?

Check if your professional license has ever been suspended or revoked (or if it is under investigation).

Have you ever been convicted of a crime that would be a disqualifying condition for the position for which you are applying? *

Yes.
No.

Conviction will not automatically disqualify you. All facts and circumstances will be considered. If yes, please give full details, including offense, date, place, and explanation.

How soon are you available? *

How many shifts can you work per week? *

Please list any current job restrictions

Essential Duties?

CONFIRM: Yes, I can perform the "essential functions" of the job I am applying for.

Employment History

Name of Company *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Supervisor *

First

Last

Supervisor's Email (optional)

Type of Business *

Phone *

Please Enter Approximate Start Date *

Please Enter Approximate End Date *

Title *

Duties *

Reason for leaving *

Employment History (continued)

Name of Company *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name of Supervisor *

First

Last

Supervisor's Email (optional)

Type of Business *

Phone *

Please Enter Approximate Start Date *

Please Enter Approximate End Date *

Title *

Duties *

Reason for leaving *

Who do we contact in case of an emergency? *

What is their relationship with you? *

Emergency Contact Phone Number *

Resume

Click or drag a file to this area to upload.

Please upload any credentials (copy of state license, current TB test, current Physical, CPR card, ACLS certification, etc.)

Click or drag files to this area to upload. You can upload up to 10 files.

If you aren't able to provide these items now, please email them within 24 hours to hr@nbstaffservices.com and include your first and last name in the title along with the word "Credentials"

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal. I authorize verification of information provided on this application; and authorize the references listed above to give you all pertinent information concerning my previous employment; and release all parties from all liability for any damage that may result from First RN Staffing. *

Yes. I agree with the above statement.
No. I do not agree with the above statement.

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