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Preference & Profile:
Would you like us to automatically match up current and new jobs for you?  Then please fill out this data form for RN Nurses :

* AREAS IN RED ARE REQUIRED FIELDS
(If you wish, you only have to fill in the required fields to start job matches, but the more thoroughly you fill out this form, the more thoroughly we will be able to match up jobs for you.)


*Name:
*Home Phone:
Alternate Phone:
Best time to call (Home/Alternate):
E-mail Address:
City / State:
Highest RN Education:
Licensed in which states:
Looking for: (facility type)
 (job type)
Shifts desired: (1st Choice)
 (2nd Choice)
Will you take rotating shifts:
Hours desired: (1st Choice)
 (2nd Choice)
*Minimum Salary Acceptable:
Preferred Salary:
*Earliest Start Date:  (MM/DD/YY)
*Professional Preference: Hold down CTRL key to select multiple choices. From selection(s) at left, give your first and second choices:
(1st Choice)

(Yrs. Exp. in 1st Choice)


(2nd Choice)

(Yrs. Exp. in 2nd Choice)
Open Heart RN surgery experience:
*Total years RN experience in all areas:
*Will you Relocate:
*Geographical Preference: Hold down CTRL key to select multiple choices. From selection(s) at left, give your 1st, 2nd and 3rd choices:
(1st Choice)

(2nd Choice)

(3rd Choice)


City/Town Preference
Write the name of
City/Town(s) Preferred:		 (1st Choice)
 (2nd Choice)
Comment Box:
(Enter all information not covered above including certifications, advanced skills and specific geographical locations desired.)
Resume Box:
(Cut and paste your resume here, or we can get it later by fax if you prefer: Don't worry how the resume looks in this box as it will be aligned correctly when submitted.)
(Be sure to check and double check your entries, when finished click add button to SUBMIT)