Apply to Join Our Team
Advanced Specialty Nursing
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Do you authorize ASN to contact you via text/sms at the number provided?
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Your City
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Your State
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Nearest Large City To You
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In order to be chosen to accept PRN assignments, you will be required to have an active, unencumbered registered nurse license. Please list the professional license you currently hold.
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Please Select
MD
Pharmacist
RN
LPN
CMA
CNA
Paramedic
EMT/EMT-B
CST
Respiratory Therapist
HHA / Companion
Admin / Registration (Short Term Project Team)
Admin (In Office)
This position is a PRN (per-diem) position, do you understand that once onboarded you will be a subcontractor (1099) with ASN, and not an Employee (W-2).
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I understand and wish to continue.
I do not wish to continue.
You must be a licensed Registered Nurse for this position. What state(s) are you licensed to practice in?
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Do you have any pending, current or previous Nursing Board disciplinary actions, restrictions or infractions OR are under treatment programs that directly or indirectly affect your RN license?
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No
Yes
If yes, please explain.
Do you have a valid Driver's License, current auto insurance and reliable transportation?
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Yes
No
Do you have a clear background check, can pass a drug screen (random), and have a valid RN Professional License?
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Yes
No
We use all electronic documentation and recommend for ease of use to perform documentation on an iPad or other tablet devices. Do you already own an iPad or tablet you can use for nursing visit documentation (with or without data capabilities)
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Yes
No
Do you currently work?
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Yes
No
What is your availability like during the week, including weekends to pick up PRN visits?
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Some opportunities that will be presented for assignment, may include a 2 hour drive time radius. Understanding that we reimburse drive time as well as visit pay, would you periodically be willing to drive within a 2 hour radius?
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Yes
No
Do you have proof of CPR?
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Yes
No
Do you have TB skin test results within the past year?
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Yes
No
If not, are you able to obtain?
Yes
No
Do you understand the risk of Hepatitis B (HBV) and have received a vaccination or waived vaccination at this time?
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I understand the risk of HBV and waive vaccination at this time, however, understand that I may become vaccinated at any time in the future
I understand the risk of HBV and have been vaccinated
How would you describe your experience with starting IV's?
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How would you describe your current ability when performing IV therapy?
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When was the last time you started an IV?
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How did you hear about ASN?
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