First Name *

Last Name *

Phone

Email *

How did you hear about ElitePro? *

Nursing Role *

Credentials *

License #
State
Expiration
Certification
Expiration

Years of Experience *

Specialty/Unit Preference

Special Skills

IV Therapy

Ventilator Care

Wound Care

Phlebotomy

Additional Skills

optional

Availability to Start

Are you legally authorized to work in the United States? *

Yes

No

Will you now, or in the future, require visa sponsorship? *

Yes

No

Are you fully vaccinated against COVID-19?

Yes

No

Are you vaccinated against influenza?

Yes

No

Do you have an up-to-date TB screening/physical exam (within 12 months)?

Yes

No

Do you consent to background check & employment verification? *

Yes

No

Reference 1: Full Name *

Reference 1: Supervisor/Manager *

Reference 1: Phone *

Reference 1: Email *

Reference 2: Fulll Name *

Reference 2: Peer/Colleague *

Reference 2: Email *

Reference 2: Phone *

Emergency Contact *

Emergency Contact Phone *

Upload Resume *

Upload License/Certifications

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By checking this box, I consent to receive SMS text messages from ElitePro Healthcare Staffing LLC regarding staffing updates, scheduling information, interview reminders, credentialing updates, and other work related communication. Message and data rates may apply. Reply STOP to opt out. Reply HELP for assistance.

By checking this box, I consent to receive SMS text messages from ElitePro Healthcare Staffing LLC regarding staffing updates, scheduling information, interview reminders, credentialing updates, and other work related communication. Message and data rates may apply. Reply STOP to opt out. Reply HELP for assistance.

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