Skip to content
Call Us: 423-443-3233
Assist Medical Staffing
Medical Staffing Agency
Home
About Us
Employers
Job Seekers
Contact
Search Jobs
Home
About Us
Employers
Job Seekers
Contact
Contract Application
You are here:
Home
Contract Application
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Phone
*
Shift Preference
*
Select Shift
1st Shift
2nd Shift
3rd Shift
Years of Experience
*
-
Less than 1 year
1-5 years
6-10 years
10+ years
Are You COVID Vaccinated?
*
Select
Yes
No
Do You Require Housing Assistance?
*
Select
Yes
No
Preferred Tax Status
*
Select
W2 (Taxes Are Taken Out)
1099 (Taxes Are Not Taken Out)
Date of Birth
*
Background Check: Will be preformed as part of the application process.
Social Security Number
*
Background Check: Will be preformed as part of the application process.
Zip Code
*
Comment or Message
I Agree
*
By checking this box, I authorize AMS and Facility to verify information provided as a part of the application process.
Message
Submit
Go to Top
