Independent_Contractor_Application-converted

Independent Contractor Application

Independent Contractor Application Ready-Set-Nurse, LLC is committed to the promotion of equal opportunity for all persons employed, engaged, or seeking employment or engagement as an independent contractor, without regard to race, color, creed, national origin, sex, age or handicap. It shall be the policy of Ready-Set-Nurse, LLC to provide equal opportunity to all applicants for employment and/or engagement as an independent contractor and to administer in accordance with that policy all personnel practices such as recruitment, selection, training, promotions, terminations, transfers, layoffs, compensation, benefits and other terms. Ready Set-Nurse, LLC wishes to ensure the furtherance of the principles of equal employment opportunity by basing all personnel decisions, which affect independent contractors or employment applicants, on only valid and necessary criteria.
Date

MonthDayYear
Date
Position (Check one)

Registered NurseLicensed Practical NurseCertified Nursing Assistant
Name (Last, First, MI)
SS # Last 4 digits
D.O.B.
Home Address
City
State
Zip
Day Time Phone
Evening Phone
Email Address
example@example.com
How long have you lived at this address?
List last three previous addresses and dates:
1. 2. 3.
Emergency Contact Person
Name
Phone
Relation
Dr’s Name
Phone
We RACE to your STAFFING needs!

Emergency Contact Person