Job Application Form
Focal Point Medical Staffing
Please select position your Applying for (MUST RESIDE WITHIN 60miles of location)?
*
LPN/RN School PEDs Nurse Wilson, NC (PRN M-F 7:30a-3:30p $38LPN-$48RN)
CNA, Salem, VA (4 Week 3-11p Contract $24/hr)
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
What position are you applying for?
*
Please Select
LPN
RN
Med Tech
CNA
Phlebotomist
Available start date:
*
-
Month
-
Day
Year
Date
What shift times are you available to work?
*
Days
Afternoons
Nights
What shifts hours are you available to work?
*
8hour
12hour
Some of our clients require background checks. Is there anything on your background check within the last 10 years outside of traffic violations?
*
Yes
No
If Yes, please provide a short description of the charge and the date the incident occurred. This includes any pending charges.
How do you prefer to submit your resume?
*
Upload File
Provide URL
Upload Resume
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Negative TB test within 12mnths or Chest X-Ray
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Current CPR
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Covid Vaccination (Preferred not Required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Healthcare License Registry (CNA, Med Tech, LPN, RN, Phlebotomist)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Last 4 digits of SS#
*
Please upload a copy of your Social Security Card. (This will be used to background check and Drug screen)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Drivers License or Passport
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Contact US!
919-578-9101 Staffing@focalpointstaff.com
Submit
Should be Empty: