Apply Now - Nursing Jobs America

Message Board

American Nurses Application Form

Personal Information:
Prefix:	Mr. Miss. Mrs.
Complete Name :

Please Choose a Username & Password:
username :
password :

Current Address Information:
address :
City :
State :
Country :
Today's Date :
Social Security :
Day Phone :
Evening Phone :
Cell Phone :
Email Address :
Classification :

Professional Information:
Visa Status (Foreign) :
Specialties :
Date Available :

Nursing School Information:
Degrees :
Graduation Date :
Certifications :
Institution :
City :
Country :
Degree :
Honors :

Job Availability & other Questions
Available on Weekends?	Yes No
Available for Night Shifts?	Yes No
Preferred Shift?
First Option City Desired
Second Option City Desired
Third Option City Desired
State(s) Licensed?
do you have any pending on your professional license?	Yes No
Have you ever held any professional license under any other name(s) in any state?	Yes No
Have any Professional liability claims ever been filled against you?	Yes No
Have you, or are receiving treatment for a drug or alcohol dependency?	Yes No
Have you ever been hospitalized for a chemical dependency?	Yes No
Have you ever been convicted of a felony?	Yes No
Do you have a physical or mental impairment that would intefere with your job?	Yes No
Have you ever been reported to the State Board of Nursing?	Yes No
If one of the previous answers was "yes", please explain

Employment History
Most Recent Job:
Employer Name :
City :
State :
Country :
Employed from :
Employed to :
Previous Job
Employer Name :
City :
State :
Country :
Employed from :
Employed to :

Personal & Profesional References
Reference 1
Complete Name
How long Know
Title
Phone Number
Reference 2
Complete Name
How long Know
Title
Phone Number

Comments :
	Submit ->

PLEASE READ CAREFULLY

I certify that the statements made on this application are true and correct to the best of my knowledge and belief and hereby grant NursingJobsAmerica.com permission to verify such answers. I understand that any false statement on this application will be considered as sufficient cause for rejection of this application or for dismissal if such false statement is discovered subsequent to my employment. I authorize written access to any records concerning my education or employment background. I understand, that if, any inquiry is made, all information as to its nature and scope will be supplied upon written request. I will have to pass a post-employment physical examination, as a condition of employment. If this application is considered favorably, I agree to abide by and comply with all the employer’s rules. Your ability to complete this application clearly and effectively will be considered requirement for the job for which you are applying.

NursingJobsAmerica.com is an equal opportunity employer. We comply with all applicable laws of the State of Florida and the Federal Government regarding employment practices. These statutes prohibit discrimination in employment based on race, color, sex, age, nationality, creed, and physical or mental disability