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Travel
Positions
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Are
you a traveler, or willing to consider travel positions?
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Yes
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No |
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In
what states would you like to consider working?
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Please
list specific cities, or other states, if desired
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| Are you
presently working for a Traveling Nurse
Agency: |
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Yes |
No |
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If
yes, with which agency are you currently working?
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What
agencies have you worked for in the past (if any)?
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What
did you like about them?
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What
did you dislike about them?
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What
would be your preferred start date?
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Are
you willing to float?
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Yes |
No |
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| If so, in what areas
can you float? |
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Are
your license, certifications, immunizations, and Health Statement up to
date?
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Yes |
No |
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| What is/are your area
of specialty/specialties? |
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| Have you ever been
credentialed in more than one
area of practice? |
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Yes |
No |
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If so which ones?
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Have
you ever abandoned/quit a contract?
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Yes |
No |
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If yes,
please explain the circumstances:
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Have
you ever been listed as DNR (do not return)?
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Yes |
No |
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If yes, please
explain the circumstances:
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Do
you have 12 or more months of full-time clinical experience totaling
2,080 hours or more in the last 3 years?
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Yes
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No |
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What
would you like to obtain from your next assignment?
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Please
list data systems/clinical equipment you are familiar with:
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Do
you currently have daily access to the internet?
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Yes |
No |
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Please
list any relevant credentials you have earned:
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Please
list the states in which you are licensed:
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Rank
by importance (1-lowest, 5-highest) the following:
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Location
of work
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Pay rate
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Company
or facility
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Schedule
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Overtime
work
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Benefits
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