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Pre-Screen Application

This is the first step in initiating an employment relationship with Angel Healthcare Staffing. Please use the Notes field at the bottom to elaborate on any of your answers. Fields marked with an asterisk (*) must be completed.   Name*   Discipline*   Address*   City*   State* Please select Alabama Alaska Arizona Arkansas California Colorado connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip Code*   Phone*   Phone (Alternate)   Email Address*   Were you referred to Angel Healthcare Staffing?*  Yes  No   If referred, who referred you?   How did you hear about the Angel Healthcare Staffing web site?* Please select Newspaper Referral Print Media Internet Search Engine Careerbuilder.com Other   If other, please explain how you found angel-staffing.com.   How many hours do you desire to work each week?* Please select 12 to 24 24 to 36 36 or more   How many years of experience do you have?* Please select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25+   What are you areas of experience?* CCU ICU SICU NEURO PSYCH L & D HR/OB PP NURSERY OR PACU PEDS ER TRAUMA OTHER Hold down your Control key (the Apple key for Mac users) to select multiple items   What is your shift preference?* MON – FRI SAT & SUN ANY D12 N12 D E N Hold down your Control key (the Apple key for Mac users) to select multiple items   Do you have proof of:* State License BLS ACLS PALS NRP TB Health Statement None of the Above Hold down your Control key (the Apple key for Mac users) to select multiple items   Notes: