NSI Nursing Specialties

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To be considered for a position with Nursing Specialties, please fill out our online application form. After submitting the form you will be asked to provide answers to our Interview Questionnaire.
Position you are applying for*
Second position you are applying for (optional)
Name*
Nursing License #*
Address*

Street Address

Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
Home Telephone*
Work or Alternate #*
Cell Phone Carrier*
Email*
Referred By*

License Information
Type of license
Expiration

MonthDayYear
MM/DD/YYYY
License #

Education Background
High School*
High School City*
Did you graduate?*

YesNo
High School Degree Obtained*
College*
College City*
College Years Attended*
Did you graduate?*

YesNo
College Degree Obtained*
Postgraduate Education*
Postgraduate College City*
Postgraduate College Years Attended*
Did you graduate?*

YesNo
Postgraduate Degree(s) Obtained*
Business/Trade School*
Business/Trade School City*
Business/Trade School Years Attended*
Did you graduate?*

YesNo
Business/Trade School Degree(s) Obtained*

Work History

Please provide your work history from your most recent employer.
Position Title*
Month & Year Worked From*
Month & Year Worked To*
Name of Employer*
Employer Address*

Street Address

Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
Employer Phone Number*
Job Duties*
Likes About Job*
Starting Salary*
Ending Salary*
Immediate supervisor's name*
Supervisor's Job Title*
Reasons for job change*

Work History Continued

Please provide your work history from another job.
Position Title*
Month & Year Worked From*
Month & Year Worked To*
Name of Employer*
Employer Address*

Street Address

Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
Employer Phone Number*
Job Duties*
Likes About Job*
Dislikes about job*
Starting Salary*
Ending Salary*
Immediate supervisor's name*
Supervisor's Job Title*
Reasons for job change*
May we contact the employers listed above for references/job history?*

YesNo
Are there any other experiences, skills, or qualifications which you feel re relevant to this job that have not already been mentioned?*
Please verify that you are human*
Terms & Authorization

I hereby certify that the answers given by me to all the questions contained on this application form are true and correct to the best of my knowledge. If employed by the company, I will comply with all the rules and regulations of the company. I agree to submit to a physical examination (if required). I also authorize my former employers to give any information they have regarding me, whether or not it is on their records. I hereby release them and the company from all liability for any damage whatsoever for issuing the same. I understand that if any fraudulent information is given on this application it may be grounds for immediate termination for my position. Nursing Specialties is an equal opportunity employer. I understand that job positions are placed equally without discrimination because of race, color, creed, religion, sex, national origin, sexual preferences, handicaps, or age.
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License Information

Education Background

Work History

Work History Continued