Prime HealthCare Staffing-Fast Form
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Fast Form

No time to waste? Just complete our Fast Form below and we will contact you shortly. Or if you prefer, call or email us for immediate attention.

Part 1: Applicant Information

*Indicates a required field
*Name:
Address 1:
Address 2:
City:
State:   *Zip: 
*Phone:
  Best time to call:  (EST)
Cell Phone:
  Best time to call:  (EST)
*Email Address:

Part 2: Profession
Select your profession:






Speciality:

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Desired work setting:

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Job Type:

(Check all that apply)





Part 3: Additional Information
What States would like to work in?

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What States are you currently licensed in?

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What is the earliest date you
are available to work?
How did you hear about Prime
HealthCare Staffing?

Part 4: Upload your resume
Please attach you resume in an MSWord ".doc" or any other word processors ".rtf" file type by clicking the "Browse" button below.
Attach Resume:

   

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