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Title:
--Select--
Administrative
Claims_Rep
CNA
Companion
Cook
COTA
Data_Entry_Clerk
Dietary Aide
Dietary Technician
Dietician
File_Clerk
Housekeeping
Lab Tech
LPN
Maintenance Worker
Med Coord
Medical_Asst
Monitor Tech
MRC
NP
Nurse(SUP)
OR Tech
OR Tech
OT
PA
PCA
PCT
Pharmacy_Tech
Phlebotomist
Psych Tech
PT
PTA
RN
RNManager
RNSupervisor
RVT
Secretary
Social Worker
Stock Worker
Surg_Tech
Trans_Coord
First Name*:
Last Name*:
Address Line #1*:
Address Line #2:
City*:
State*:
--Select--
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
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NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip*:
Home Phone:
Work Phone:
Cell/Mobile Phone:
Email*:
Do you require sponsorship
to work in the US?:
--Select--
Yes
No
Work Preference:
Hospital
Nursing Home
Homecare
Adult Care
Pediatric Care
Travel Nursing
Your Specialty:
ICU/CCU
Telemetry
Emergency Room
Operating Room
Medical/Surgical
NICU
Pediatrics
IV
PACU
Case Management
Mental Health
Hospice
Director of Nursing
Other:
What other experience do you have?
Where would you like to work:
New York
Bronx
Brooklyn
Queens
Westchester County
Staten Island
Manhattan
Long Island
Rockland County
Assignment Preference:
Check all that apply:
Full Time
Part Time
Per diem
Contract
Daytime
Evening
Overnight
Availability Status( when are you
available for orientation/
job assignment):
How did you hear about Allen
Medical Staffing Inc.?:
Advance for Nurses
Careerbuilder
Nursejobz
Healthdirection
Healthjobsusa
Hospitaljobsonline
Friend
Nursejobz
Job Fair
Military advertisement
Military transition office
Monster
Newspaper
Nurseweek
Nursing flyer/Direct Mailer
Nursing Jobs-online
Nursing School
Nursing Spectrum
RN Career Magazine
State Boards of Nursing
Other
Other:
Attached Resume*:
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