Part 1: Applicant Information

*Indicates a required field

*Name:

Address 1:

Address 2:

City:

State:

*Phone:

Cell Phone:

*Email Address:

Part 2: Profession

Select your profession:

PT OT SLP PTA COTA

School Nurse School Social Worker

School Psychologist Special Education Teacher

Specialty:

(Check all that apply, hold Ctrl key for multiple selections - Mac users, hold Command key)

Desired work setting:

(Check all that apply, hold Ctrl key for multiple selections - Mac users, hold Command key)

Job Type:
(Check all that apply)

Travel Assignment
Local Temporary
Direct Placement
Temporary to Hire
Education Staffing Services

Part 3: Additional Information

What States are you currently licensed in?

(Check all that apply, hold Ctrl key for multiple selections - Mac users, hold Command key)

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.