Healthcare Staffing Agency
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(956) 683-1212
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Be specific on what jobs/work you are interested in pursuing
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Applicant Name
Phone Number
Discipline / Specialty
Assignment Type: (Select all that apply)
Travel Contract
Local Contract
Per Diem (PRN)
Temporary to Permanent
Contract Duration: (Travel Positions)
4 to 6-Weeks
8-Weeks
13-Weeks
26-Weeks
Location(s) Desired
Preferred Method of Communication:
Phone Call
Email
Text Message
Classification
Select From Dropdown
Certified Nursing Assistant (CNA)
Licensed Practical Nurse (LVN)
Medical Assistant (MA)
Registered Nurse (RN)
Respiratory Therapist (RT)
Other
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Email Address
Years of Clinical Experience
Shift Preference: (Select all that apply)
Days
Mids
Nights
Guaranteed Hours Per Week: (Travel Positions)
36-Hours
48-Hours
60+ Hours
Available Start Date
How Did You Hear About Us?
Friend / Coworker
Job Site (e.g. Indeed, LinkedIn)
Search Engine (e.g. Google, Bing, Yahoo)
Social Media (e.g. Facebook, Twitter, LinkedIn)
Additional Information:
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