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Name
First
Last
Email
Phone
Date
MM slash DD slash YYYY
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
License/Certification Type (e.g., RN, LPN, CNA, etc.)
RN
LPN
CNA
License Number
(Required)
State of Licensure
(Required)
Specializations (e.g., ICU, ER, Geriatrics, Pediatrics, etc.)
ICU
ER
Geriatrics
Pediatrics
Preferred Work Settings (e.g., Hospital, Clinic, Long-term Care, etc.)
Hospital
Clinic
Long-term Care
Years of Experience
(Required)
Preferred Job Type
(Required)
Full-time
Part-time
Per Diem
Preferred Shift
(Required)
Day
Night
Weekend
Resume/CV Upload (PDF or Word file)
(Required)
Max. file size: 10 MB.
License/Certification Upload
(Required)
Max. file size: 10 MB.
Additional Documents (e.g., CPR card, immunization records, etc.)
(Required)
Max. file size: 10 MB.
Are you authorized to work in the U.S.? (Yes/No)
(Required)
Yes
Now
Are you willing to travel? (Yes/No)
(Required)
Yes
Now
Message/Additional Notes (Optional text box for comments)
Agreement Checkbox
(Required)
I certify that the information provided is accurate and complete to the best of my knowledge.
I agree to the terms and conditions of Hunk Medical Staffing Agency.
