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Apply to Intensive Care Unit (ICU) Registered Nurse (RN) Per Diem - Covina, CA

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PERSONAL INFORMATION

First Name

Last Name

Mobile Phone

Email

Current Address

City

State

Zip Code

POSITION INFORMATION

Position Applying For

RN

LVN

CNA

Surgical Technician

Respiratory Therapist

Clinical Laboratory Scientist

Phlebotomist

Medical Assistant

Nuclear Medicine Tech

CT Tech

MRI Tech

Physical Therapist

Social Worker

Other

Specialty

ICU

ER

MS

Tele

PACU

OR

Cath Lab

IR

NICU

Peds

PICU

Others

Years of Experience in current specialty

Employment Type

Travel

Per Diem

Contract

Temp-to-Perm

Permanent

Part-time

Preferred Shift

Day

Night

Mid

Rotating

Weekend

Preferred Location(s)

Earliest Available Start Date

Best Time To Call

PROFESSIONAL LICENSURE

Certificate/License Number:

Certificate/License Issuing State

License Status

Active

Compact

Pending

License Expiration Date

EDUCATION

School Name

School City & State

Degree /Certification

Certificate

Vocational Course

Associate Degree

Bachelor's Degree

Master's Degree

Field of Study

Graduation Date

EMPLOYMENT HISTORY

Facility Name

Job Title

Employment Dates (Start & End Date) or Present

Start & End Date or Present

Supervisor Name & Phone Number

Reason for Leaving

CERTIFICATION & SKILLS

Check all that apply

Certifications & Skills

BLS

ACLS

PALS

NIHSS

MAB

NRP

IV Therapy

Professional References

2 Professional references from unit charge nurse, supervisor or manager

Reference Name

Reference Job Title

Charge Nurse, Supervisor, Manager

Facility/Organization

Reference Phone Number

Reference Email

Reference Name 2

Reference Job Title 2

Facility /Organization 2

Reference Phone Number 2

Reference Email 2

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Upload ACLS

Upload PALS

Upload MAB

Upload NIHSS

Upload Diploma or Certificate

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