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Contact Info
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Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mobile Phone
*
Best time to call
*
Date of birth
*
Soc Sec Number
*
How did you hear about us?
*
Select from dropdown
Indeed
Nursefly
Allied Travel Careers
Referred by a Friend
WebSearch (Google,Yahoo,Bing etc)
Don't remember so it must be Destiny
Qualifications
Medical Profession
*
Years of Experience
*
Less then 1 year
1 - 3 years
4 - 7 years
8 - 10 years
11 - 15 years
16 (+) years
Are you certified?
*
YES
NO
Certification
*
Active State Licenses
*
Use State abbreviations to notate active state license (if applicable)
Do you have prior travel experience?
*
YES
NO
Do you have a current BLS?
*
YES
NO
Is your BLS issued through American Heart Association?
*
YES
NO
References
Please submit 3 supervisor/manager references from the past year. If you are a traveler, please provide a supervisor reference from your most recent travel assignment.
Reference #1: Name
*
First
Last
Title
*
Facility
*
Employment Dates
*
Phone Number
*
Email
*
Reference #3: Name
*
First
Last
Title
*
Facility
*
Employment Dates
*
Phone Number
*
Email
*
Reference #2: Name
*
First
Last
Title
*
Facility
*
Employment Dates
*
Phone Number
*
Email
*
Do we have permission to reach out to these references?
*
Yes
No
Please wait. Let's discuss first.
Availability
I can start a new contract on this date.
*
I need these dates off
*
Job Preferences
Shift Preference
*
Days
Evenings
Nights
Any
Travel Preference
*
Have my own car and will drive
Will fly and use public transportation to get around
Will fly and may need a rental car
Depends on the distance to assignment
Will you travel with a pet?
*
YES
NO
Housing
*
I'm a self provider and want to arrange my own housing
Prefer to have AMS arrange my housing
Location Preference
*
Open to anywhere
Specific geographic areas and/ or states (specify below)
A certain radius or drive time from home (specify below)
Lets discuss it and come up with the best gameplan for me
Please specify if need be.
*
Background
1) Has your license or certification ever been investigated or suspended?
*
YES
NO
3) Have you ever been convicted of a crime other than a minor traffic violation?
*
Yes
No
2) Have you ever been named as a defendant in a professional liability action?
*
Yes
No
If you answered "Yes" to one of the above questions (1 - 3), please explain:
*
Comments
*
General comments or anything you'd like us to know about you?
Upload Resume
Upload Resume
*
Max file size: 20MB
Upload Records
*
Max file size: 20MB
We'll take Shot Records, BLS, Driver's License, Immunizations. Anything you'd like to send is helpful.
Upload Recommendation Letters
*
Max file size: 20MB
Submit
Home
Traveler
Featured Travelers
Refer a Friend
Client
Request Staff
About Us
Contact Us
JCAHO Certification
Apply
Quick App
Full Application
