Online application Our team Is ready for you to join Step 1 of 6 - Applicant Information 0% Applicant InformationToday's Date* MM slash DD slash YYYY Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth Month Day Year Phone*Email Position Applied For (Choose ONE)* Full-time Nursing - Insertion Casual- Clinic Infusion Nurse Home Health Casual Nursing - Infusion Home Health Part-time Nursing - Infusion Billing and Coding Administrative Date Available to Start* MM slash DD slash YYYY Has Your Nursing License Ever Been Suspended?* Yes No If Yes, Explain*How did you hear about us?*Indeed, Website, Reference (who?) Applicant Eligibility to WorkAre You a Citizen of the United States?* Yes No Are You Authorized to Work in the United States?* Yes No Have You Ever Worked for this Company?* Yes No If Yes, list position and employment end date.*Have You Ever Been Convicted of a Felony?* Yes No If Yes, Explain* EducationHighest Level of Education Obtained* High School/GED RN Diploma ADN or Associate Degree BSN or Bachelor's Degree MSN or Master's Degree APRN Degree Other Current EmployerAre You Currently Employed?* Yes No Company*Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job Title*Current Salary*Responsibilities*Current Supervisor Name*May We Contact Your Current Supervisor for a Reference?* Yes No Previous Employer #1Company*Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor*Job Title*Starting Salary*Ending Salary*Responsibilities*Reason For Leaving*May We Contact Your Previous Supervisor for a Reference?* Yes No Previous Employer #2CompanyPhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesReason For LeavingMay We Contact Your Previous Supervisor for a Reference? Yes No Resume and Letter of Rec - Please Upload Your Most Current Resume BelowResume*Max. file size: 50 MB.Upload and attach your resumeLetter of RecommendationMax. file size: 50 MB.Please attach a letter of Rec or have them send it to HR@vascularaccessplus.com DisclaimerI certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision, including verification of professional license as required and background investigations which may include an examination of educational credentials, criminal convictions, and driving records as required by the responsibilities of the position. I understand that employment with Vascular Access Plus may be contingent upon completion of a urine drug screen, physical assessment, background check including education, professional licensure / certifications, criminal convictions, and employee references. This application of employment shall be considered active for a period of time not to exceed forty five (45) days. Any application wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the nurse may resign at any time, and Vascular Access Plus may discharge the nurse at any time with or without cause. It is further understood that this “at will” employment relationship may not be charged by any written document, or by conduct, unless such changes are specifically acknowledged in writing by an authorized executive of Vascular Access Plus. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge. I understand, also, that I am required to abide by all the rules and regulations set forth by Vascular Access Plus. Submitting this online job application indicates that I have read the job description for the position and can carry out the duties and responsibilities stated therein.
