Emergency Staffing Professional Profile

Shift Availability*

Days (7a-7p)Nights (7p-7a)Evenings (3p-11p)Variable

Day Availability*

Weekend Availability*

EveryEvery otherOne per monthNone

Holiday Availability*

AllSomeNone

Available for:*

Last-minute emergency shifts (<4 hours notice)Same-day needs (4-12 hours notice)Next-day coverage (12-24 hours notice)Advance scheduled shifts (>24 hours notice)

Minimum Hours Per Shift*

4812Other

Maximum Hours Per Week*

SMS Text Notifications*

YesNo

Preferred Settings*

Unit/Department Preference

Specific Facility Preferences

Facilities to Exclude

Hourly Rate Expectation*

Consider lower rates for:

Preferred facilitiesGuaranteed hoursLast-minute premium

Our emergency staffing model requires professionals who can respond rapidly to critical staffing situations. Please indicate your commitment level:*

Platinum Responder - I can respond to emergency staffing requests within 2 hours of notification at least 3 days per weekGold Responder - I can respond to emergency staffing requests within 2 hours at least 1-2 days per weekSilver Responder - I require at least 4 hours notice for emergency staffing requestsStandard Responder - I prefer 12+ hours notice for all shifts

Reference #1 *

First NameLast Name

Title*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Facility name *

Reference #2 *

First NameLast Name

Title *

Facility name *

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Special Skills/Qualifications

How did you hear about us?

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Relationship*

By submitting this form, I confirm that all information provided is accurate and complete. I understand that joining the Advanced Global Healthcare emergency staffing pool may require rapid response to staffing needs, and I am committed to maintaining the professional standards required for emergency healthcare staffing.

NEXT STEPS:

Submit this completed form with a copy of your license, certifications, and resume
Complete our skills assessment and background check authorization
Schedule your professional interview and orientation
Join our exclusive emergency staffing deployment pool

A copy of your license

Certifications

Resume

Emergency Staffing Professional Profile

PERSONAL INFORMATION

PROFESSIONAL QUALIFICATIONS

AVAILABILITY & PREFERENCES

FACILITY TYPE PREFERENCES

COMPENSATION REQUIREMENTS

EMERGENCY RESPONSE COMMITMENT

PROFESSIONAL REFERENCES

ADDITIONAL INFORMATION

EMERGENCY CONTACT

ACKNOWLEDGMENT