Total Healthcare Staffing Employment Application

Employment ApplicationTotal Healthcare Staffing is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Full Name* This field is required.

First Name

Last Name

Phone Number* This field is required.

Area Code

Phone Number

E-mail* This field is required.

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Position(s) applying for* This field is required.

Desired Pay Rate* This field is required.ex. hour pay rate

In which state(s) or jurisdiction(s) do you have a valid nursing license or compact license to work? (Select all that apply)* This field is required.Check all that apply

Compact License (Multi-state License)

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Canada

Nurse and Administrative Position(s) applying for?* This field is required.Check all that apply

Accounting Clerk

Activities Aide

Activities Director

Acute Care Nurse (RN)

Cardiovascular Nurse

Casework Assistant

Certified Medication Aide (CMA)

Certified Nursing Assistant (CNA)

Clinical Nurse Specialist (CNS)

Critical Care Nurse

Critical Care Transport Nurse

Cruise Ship Nurse

Dental Assistant

Dental Hygienist

Dermatology Nurse

Dialysis Nurse (RN)

Dialysis Technician

Dietary Aide

Dietary Supervisor

Director of Nursing (DON)

Diagnostic Medical Sonographer

Emergency Flight Nurse

Emergency Room Nurse

Forensic Nurse

Gastroenterology Nurse

Geriatric Nurse

Home Care Skilled Nurse

Home Health Aide (HHA)

Home Health and Personal Care Aide

Infusion Nurse (RN)

IV Therapy Nurse (RN)

Infectious Disease Nurse

Licensed Practical Nurse (LPN)

Magnetic Resonance Imaging (MRI) Technologist

Massage Therapist

Medical Assistant

Medical Equipment Preparer

Mental Health Technician

Nephrology Nurse

Neurology Nurse

Nuclear Medicine Technologist

Nurse Administrator

Nurse Anesthetist (CRNA)

Nurse Case Manager

Nurse Educator

Nurse Informaticist

Nurse Manager

Nurse Midwife (CNM)

Nurse Practitioner (NP)

Nurse Researcher

Nurse Staffing Coordinator

Nurse Supervisor

Nursing Assistant

Obstetrics and Gynecology Nurse (OB/GYN Nurse)

Occupational Health Nurse

Occupational Therapist

Occupational Therapy Assistant

Oncology Nurse

Operating Room Nurse

Orthopedic Nurse

Pain Management Nurse

Palliative Care Nurse

Paramedic

Patient Care Technician

Pediatric Nurse

Personal Care Aide

Phlebotomist

Physical Therapist Aide

Physical Therapist Assistant (PTA)

Psychiatric Aide

Psychiatric Nurse

Public Health Nurse

Radiologic Technologist

Radiology Nurse

Registered Behavior Technician (RBT)

Registered Nurse (RN)

Registered Nurse Supervisor

Rehabilitation Nurse

Respiratory Therapist

School Nurse

Sonographer

Speech Language Pathologist (SLP)

Speech Language Pathologist Assistant

Surgical Technologist

Travel Nurse

Ultrasound Technologist

Urology Nurse

Vascular Sonographer

Are you available to work?* This field is required.Check all that apply

Full time

Part time

Per-diem

Day

Evening

Night

Weekdays

Weekends

7am - 3pm

3pm - 11pm

11pm - 7am

Select ALL EMR/EHR experience:Check all that apply

Experience: Cerner

Experience: Epic

Experience: Meditech

Experience: McKesson

Other

CertificationsPlease list all current certifications relevant to your nursing role (e.g., BLS, ACLS, PALS, IV Certification, WCC, etc.). You may be asked to provide documentation during the onboarding process.

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Please sign your Full Name* This field is required.I certify that the information I have provided is true and complete to the best of my knowledge. I understand that falsification of information may result in refusal of employment or termination. I acknowledge that employment is contingent upon verification of my background, credentials, and compliance with company policies.

Please enter date* This field is required.

Date

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Total Healthcare Staffing Employment Application