PRIME TIME HEALTHCARE - APPLICATION FOR EMPLOYMENT

Please complete the application below and be on your way towards an adventure together with Prime Time Healthcare. (All Fields are Required)

Are you a referral of someone? If so, please provide a name

Personal Information

First Name
Last Name
Are You a US Citizen?
Email
Retype Email
Home Phone
Cell Phone
Job Title
(RN, LPN, CNA, etc)
Modality / Specialty
(Long Term Care, Hospice, Corrections, Clinic, Operating Room, L+D, ER, ICU, etc)
Permanent Address
City
State
Zip

Education

Location 1
Name of Institution / School
City
State
Degree Obtained
Date Completed (MM / YYYY)
Add Another Institution / School

Work History

Prime Time Healthcare will need to obtain 7 years of work history - if applicable.  Please add as many jobs as possible.
Job 1
Name of Facility
Was this position through a staffing agency? Yes
If Yes, please state which staffing agency you worked there with:
City
State
Start Date (MM / YYYY)
End Date (MM / YYYY)
Job Title
Modality / Specialty(s) worked
Shift / Hours worked
Reason for Leaving
Add Another Job

Professional References

References must be within the last 2 years and must be from a charge nurse, manager, director, administrator, or supervisor position
Reference 1
Name *
Title *
Facility
Start Date (MM / YYYY)
End Date (MM / YYYY)
Phone *
* = RequiredAdd Another Reference

Acknowledgement:

I certify all information is true, accurate, and to the best of my knowledge. Any falsification of information provided above, may result in immediate termination of my employment with Prime Time Healthcare.

I understand and agree, typing my name below, will constitute as my signature.
Name
Date

Submit Application

PRIME TIME HEALTHCARE Travel Nursing Jobs RN, LPN, CNA

PRIME TIME HEALTHCARE
Travel Nursing Jobs RN, LPN, CNA

Locations


Corporate Head Quarters
15380 Weir St.
Omaha, NE 68137

Hours
Mon - Fri
8am - 5pm CST

Contact


Toll Free
888-269-9261

Local
402-933-6700

Fax
402-933-6710

Email
Contact Us

Info


Privacy Policy
Terms of Use
The Joint Commission
Contact Info
Continuing Education Links Employee Handbook Handbook Acknowledgment Form
the Joint Commission Gold Seal for Health Care Staffing