LVN Strike Document
Submission Form
Recruiter
Please Select
Kaitlyn Maxon
Lucas Hopkins
Stephen Martin
Micah Digre
Inaki Suarez
Trinity Chan
Robert Bales
NEW INQUIRY/APPLICATION
Clinician Info
Legal Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
DOB
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SSN#
*
Do you have at least 1 year of experience in the past three of working as an LVN/LPN in the Emergency Room?
*
Yes
No
In which of the following settings do you have recent work experience as an LVN/LPN?
*
Inpatient
Outpatient
Home Health
Are you licensed to work as an LVN/LPN in California without restrictions?
*
Yes
No
License Number:
*
Documents for Profile
Resume
*
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Please upload your resume in word doc, or PDF format. *Pictures of resume's are not accepted*
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Please confirm agency name, and facility for each contract listed on your resume.
**Agency details are required for compliance and verification purposes. This MUST be provided within 24–48 hours of submission. Profiles cannot move forward to offer without this information.**
Certifications: I.V. Cert, BLS and CA License
*
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Please upload all current and active certifications
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Drivers License:
*
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Please upload all current and active certifications
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