Job Application Form
Focal Point Medical Staffing
Please select position your Applying for (MUST RESIDE WITHIN 60miles of location)?
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
*
Format: (000) 000-0000.
What position are you applying for?
*
LPN
RN
Med Tech
CNA
PCA
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?
*
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Provide URL
Upload Resume
*
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(2) Professional References (Name, Title, Facility, Phone number, Email address)
*
Flu Vaccine (Required during Flu Season between October 1st and March 31st for Virginia Facility Client)
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Negative TB test within 12mnths or Chest X-Ray
*
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Immunization Record-2 MMR or Positive Titer-2 Varicella or Positive Titer-HEP B Series (positive Titer or Signed Declination)
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of
Current CPR
*
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Covid Vaccination (Preferred not Required)
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Healthcare License Registry or Certification (PCA,CNA, Med Tech, LPN, RN, Phlebotomist)
*
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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)
*
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of
Drivers License or Passport
*
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How did you hear about us
*
Job Board
Google
Referral
Other
Contact US!
919-578-9101 Staffing@focalpointstaff.com
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