Apply Now – Med Solutions, LLC

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about us? *

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Indeed
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I was referred by:

Please enter the name of the person that referred you.

Are you 18 years or older? *

Date of Birth *//

Phone *

Cell Phone *

Email *

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Have you ever applied with Med Solutions? *

If yes, when?

Have you ever worked for Med Solutions? *

If yes, when?

What position?

Will you be able to attend work regularly and conform to working hours required? *

Name of High School Attended *

Address of High School

Address Line 1

Address Line 2

City

State

Zip Code

Year Graduated *

Name of College Attended *

Number of Years

Did you Graduate? *

Type of Degree Earned? *

Other Training?

Position? *

RN Registered Nurse
LPN Licensed Practical Nurse
CNA Certified Nursing Assistant
Certified Medical Assistant
Certified Medication Aide
Phlebotomist
Health Information Technician
PT Physical Therapist
PCT Patient Care Technician
Behavioral Health Technician
Other

Years of Experience *

License Number

Date Issued

Date of last physical//

Date of last Mantoux (TB) Test //

Wound Care Certified?

Yes, I am Wound Care Certified

Specialties? *

Hospice
Emergency care
ICU
Urgent care
Trauma care
Critical care
Neonatal and pediatric intensive care
Rehabilitative care
Psychiatric acute care
Acute care surgery
Long term care
Clinics
Doctor's office
School nursing
Occupational health
Case management
Not Applicable

Suspended License?

Check if your professional license has ever been suspended or revoked (or if it is under investigation).

How soon are you available? *

How many shifts can you work per week? *

Please list any current job restrictions

Essential Duties?

CONFIRM: Yes, I can perform the "essential functions" of the job I am applying for.

Who do we contact in case of an emergency, and what is their relationship with you? *

Emergency Contact Phone Number *

Resume

Click or drag a file to this area to upload.

If you do not upload a resume, Please give us information about at least 2 previous employers. Most recent or current employer.

Address and/or contact information

From -- Until

Second recent or current employer.

Address and/or contact information

From -- Until

Third recent or current employer.

Address and/or contact information

From --Until

Additional we will need to complete your application

We will need: Current Nursing License - Current CPR card - Physical taken within the last year - TB test given within the last 2 years results - Immunization record - Driver's License - Social Security Card -

Please upload any credentials (copy of TB test, last Physical, CPR card, ACLS certification, etc.)

Click or drag files to this area to upload. You can upload up to 10 files.

If you aren't able to provide these items now, please email them within 24 hours to hr@medsolutionspro.com and include your first and last name in the title along with the word "Credentials"

I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that any misrepresentation or omission of information is grounds for termination or dismissal of the application and/or hiring. You are hereby authorized to verify any information provided on this application. I also authorize the references listed above to supply any pertinent information concerning my previous employment; and release all parties from any liability that may arise as a result of providing such information to Med Solutions, LLC. *

Yes. I agree with the above statement.

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