NursesRx - Apply for Jobs

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Personal Information

Legal First Name Legal Last Name Middle Name Mobile Phone Email Address

Discipline/Specialty

Discipline Specialty Secondary Specialty Years of Experience in Current Discipline How did you hear about us?

Referrer's First Name Referrer's Last Name Referrer's Email Address

If other, please specify

Contact Information

Country Street Address City State/Province ZIP/Postal Code Home Phone Emergency Contact Phone

Licenses

License type

State/Province

Snap a photo (optional)

(optional)

Certifications

Check all applicable certifications and enter expiration date:

Have you ever had your license or certification, in any state, investigated, suspended or had disciplinary action taken against it?

NO YES

If yes, please give details and current status

Education

Employment

Facility / Employer name City State / Province

Current Employer?

NO YES

From (MM/DD/YYYY) Discipline

If other, please specify

Specialty / Setting

If other, please specify

Unit / Floor / Dept

May we contact your employer?

NO YES

Travel Assignment

NO YES

Citizenship
Are you either a U.S. citizen or can you submit verification of your legal right to work in the U.S.?

NO YES

If no, please give details and current status If you will be employed on a visa, please specify type of work visa

To submit your application, please agree to the terms and click SUBMIT below.

Personal Information Edit

First Name:

Last Name:

Middle Name:

Email address:

Mobile phone:

Discipline:

Specialty:

Secondary Specialty:

How did you hear about us?:

Please provide specifics:

Street Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Home Phone:

Emergency Contact Phone:

Licenses Edit

License type:

State/Province:

Uploaded license:

Certificates Edit

Certification:

Expiration Date:

Uploaded certificate:

License or certification investigated:

If yes, details:

Education Edit

Professional education / College name:

Graduation date:

Degree:

Major:

State/Province:

Employment Edit

Facility / Employer name:

City:

State / Province:

Current Employer:

From:

To:

Discipline:

Specialty / Setting:

Unit / Floor / Dept:

If other, please specify:

May we contact your employer?:

Supervisor's name:

Supervisor's title:

Supervisor's phone:

Travel assignment:

Legal to work in the U.S.:

If no, details:

Type of work visa:

By submitting this application, I agree and consent to the terms and conditions stated herein, including, but not limited to those relating to the use and disclosure of information I have provided and methods by which AMN may contact me.

I agree with the above statements.

NO YES

Date

Thanks for Completing Your Application

Congratulations on completing your NursesRx nursing application. You're now one-step closer to a rewarding career as a travel nurse. An NursesRx career specialist will review your application and contact you with any questions and to discuss next steps in the hiring process.

In the meantime, check out the following resources:

Search Travel Nursing Jobs
Design Your Ideal Jobs
Sign up for Nursing Job Alerts

Thanks for choosing NursesRx. We look forward to helping you make your travel nursing dreams come true.

Sincerely,
The NursesRx Team

Thanks! We already have your application on file.

Our records show that you've already applied with NursesRx, so there's no need to re-submit your application.

If you are interested in a specific job, please contact your recruiter directly at 1-800-735-4774.

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