On-line Career Search Request Form 

 

If you are a medical professional seeking exciting employment opportunities, simply complete the On-line Career Search Request Form below. An American Staffing representative will contact you within 24 hours of submission. Don't delay-a world of opportunities awaits you!

Thank you for choosing American Staffing Services, Inc.!

 Employee Name:  
 Position:  
 Address:  
 City:  
 State/Providence:  
 Zip/Postal Code:  
 Country:  
  Home Phone:  
 Work Phone:  
 Cell Phone:  
 Pager:  
 E-mail:  

Position Sought 
  Lab Tech   MD   Medical Assistant   MSW
  OR Tech   Nurse Aide   X-Ray Tech   Other
  PA   PT   Pharmacist  
  RN   OT   Dietitian  
  LPN   ST   MH/MR Worker  

Can you perform the essential functions of the position for which you have applied, with or without reasonable accommodation? (explain below)



How did you learn about American Staffing Services, Inc.?
Yellow Pages   Newspaper   Website   Other

What shifts do you prefer to work?
Part time   Full time   Day (7-3)   Evening (3-11)   Night (11-7)

What days are most convenient for you to work?
In what geographic areas do you prefer to be located for work?

State(s)

City(ies)


Are you willing to relocate for assignments?   Yes No
3 Months   6 Months   Longer


 Educational History

Vocational/Technical School
 Name:  
 Address:  
 Graduation Date:  
 Degree/Cert. Awarded:  
College/University
 Name:  
 Address:  
 Graduation Date:  
 Degree/Cert. Awarded:  
Other Education
 Name:  
 Address:  
 Graduation Date:  
 Degree/Cert. Awarded:  

 Employment History

Name employers starting with the most recent
 Name:  
 Address:  
 Phone:  
 Date Employed:  
 Position:  
 Supervisor:  
 Wage/Salary:  
 Reason For Leaving:  

 Name:  
 Address:  
 Phone:  
 Date Employed:  
 Position:  
 Supervisor:  
 Wage/Salary:  
 Reason For Leaving:  

 Name:  
 Address:  
 Phone:  
 Date Employed:  
 Position:  
 Supervisor:  
 Wage/Salary:  
 Reason For Leaving:  

 Professional References

Please do not list relatives
 Name:  
 Address:  
 Phone:  
 Position:  

 Name:  
 Address:  
 Phone:  
 Position:  

 Name:  
 Address:  
 Phone:  
 Position:  

 Skill Inventory Checklist

  Med. Surgery   ICU   Oncology   List Speciality(ies)
  Orthopedics   CCU   Geriatrics  
  Neurology   IV Team   Rehabilitation  
  Trauma/Burns   Pediatrics   Psych  
  Emergency Room   OB-GYN   Operating Room  

 

 

American Staffing Services, Inc.
3356 Babcock Blvd.
Pittsburgh, PA 15237
1.888.875.7865

info@americanstaffingservices.com

 

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