indicates a required field 

EXPRESS FORM

Employment with Nurses 247 is based on individual merit and qualification.Completing the On-Line Application doest not guarantee a job offer. We are an equal opportunity employer, dedicated to a policy of non-discrimination on any basis including race, creed, color, age, sex, religion or national origin.

Last Name
First Name
Address
City
State	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip
Phone	(  ) -  -
Cell	(  ) -  -
Email	I don't have email address
What is your classification ?	Select One RN LPN CNA
Please provide your specialties	Select specialties Burn Cardiac CCU CVICU Dialysis ER Geriatrics ICU L&D Med/Surg Neuro ICU NICU NICU2 NICU3 Nursery Nursing Home OB Oncology OR Ortho PACU PCU/MCU Peds PICU Post Partum Psych Telemetry Transplant
Are you eligible to work in USA?	Select One Yes No
What type of assignment are you interested in?	Select One Per Diem Contract Travel
Best Time to Reach You	Select One Early Morning Morning Afternoon Evening Night
Which state do you prefer to work out of:	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

CERTIFICATIONS	ENTER CERTIFICATION EXPIRATION DATES

ACLS Expiration:	Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013	CEN Expiration:	Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
PALS Expiration:	Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013	NRP Expiration:	Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
BLS Expiration:	Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013	Other (Hold "Ctrl" key for multiple values )	Select One ACRN AOCN APRN APRN,BC BC-ADM CAPA CARN CCNS CCRN CDE CDN CDONA/LTC CEN CFRN CGN CGRN CHN CHPN CIC CM CMCN CNM CNN CNOR CNRN CNSN COHN COHNS COHN/CM COHNS/CM CORLN CPAN CPDN CPHQ CPN CPNP CPON CPSN CRNA CRNFA CRNI CRNO CRRN CRRN-A CUA CUCNS CUNP CURN FAAPM HNC IBCLC LCCE LNCC NCSN OCN ONC TNCC Others

LICENSING INFORMATION

ENTER ALL THAT APPLY

STATE	LICENSE #	EXPIRATION		OBTAINED
ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING		Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013		Month01 02 03 04 05 06 07 08 09 10 11 12 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING		Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013		Month01 02 03 04 05 06 07 08 09 10 11 12 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING		Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013		Month01 02 03 04 05 06 07 08 09 10 11 12 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA CANADA COLORADO CONNECTICUT DELAWARE DIST OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING		Month01 02 03 04 05 06 07 08 09 10 11 12 Year2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013		Month01 02 03 04 05 06 07 08 09 10 11 12 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

AVAILABILITY & PREFERENCE						PROVIDE  AVAILABILITY & PREFERENCE

Shift Preference:

7am-3pm

3pm-11pm

11pm-7am

7am-7pm

7pm-7am

Days Available:

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Date Available to Start Work