Job Application Form
Focal Point Medical Staffing
Please select position your Applying for (MUST RESIDE WITHIN 60miles of location)?
*
CNA/RMA, Newport News, VA (PRN All shifts $24/hr)
School LPN/RN, Warrenton, NC (M-F 7:30a-3:30p)
CNA, Lexington, NC (PRN All Shifts $23.23/hr)
LPN, Lexington, NC (PRN All shifts $45/hr)
RN/LPN, School Nurse, Pinetops, NC (7:30a-3:30p M-F $38-50/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?
*
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?
*
Upload File
Provide URL
Upload Resume
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
(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)
Browse Files
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
Immunization Record-2 MMR or Positive Titer-2 Varicella or Positive Titer-HEP B Series (positive Titer or Signed Declination)
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 or Certification (PCA,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
How did you hear about us
*
Job Board
Google
Referral
Other
Contact US!
919-578-9101 Staffing@focalpointstaff.com
Submit
Should be Empty: