Prosper Workforce Solutions – Employment Application
This application is for individuals seeking employment opportunities through Prosper Workforce Solutions. Completion of this application does not guarantee placement. All information provided must be accurate and verifiable.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Are you legally authorized to work in the U.S.? (Yes or No)
*
Which type of position are you applying for?
*
Please Select
Healthcare Positions
Skilled Trades / General Labor
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Healthcare Position
Position(s) Applying For (Checkbox)
*
HHA
CNA
MA
LPN
RN
Caregiver
Do you hold an active healthcare license or certification? (Yes/No)
*
Employment Type Desired
*
Full Time
Part Time
PRN
Contract
Upload License/Certification (Required)
*
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Patient Populations Comfortable With
*
Elderly
Dementia
Behavioral Health
Developmental Disabilities
Certification/License Type (Dropdown)
*
Please Select
Home Health Aide (HHA)
Certified Nursing Assistant (CNA)
Medication Aide / QMA
Medical Assistant (MA)
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
State of Licensure
*
Any Additional Certifications
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CPR / BLS CertificationFirst Aid CertificationTB Test / Physical Clearance
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Skilled Trade/Contractor
Years of Experience
*
Trade Type (Dropdown)
*
Please Select
General Labor
Construction
Electrical
HVAC
Plumbing
Welding
Tools/Certifications (OSHA, Forklift, etc.)
*
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Availability to Start
*
Please Select
Immediately
Within 2 weeks
30+ days
Preferred Shifts (Checkbox)
*
Days
Evenings
Nights
Weekends
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Work Experience
Please Upload your current Resume
*
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Transportation & Reliability
Do you have reliable transportation?
*
Please Select
Yes
No
Maximum travel distance willing to commute?
*
Please Select
10-20 Miles
21-30 Miles
31-40 Miles
Are you able to consistently arrive on time for scheduled shifts?
*
Please Select
Yes
No
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Compliance Pre-Screen
Are you able to pass a background check?
*
Please Select
Yes
No
Are you able to pass a drug screen if required?
*
Please Select
Yes
No
Have you ever been excluded from Medicare/Medicaid programs?
Please Select
Yes
No
Have you had your license Suspended due to any reason?
*
Please Select
Yes
No
Includes your Health License to serve clients
If yes, Please Explain:
Why do you want to work through Prosper Workforce Solutions?
*
Describe your approach to professionalism in a healthcare environment.
*
Submit
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