Staffing Application - Assist Medical Staffing

Name *

First

Middle

Last

Email *

Phone *

We Do Not Provide Housing Assistance *

Stop here if you require housing assistance. Our pay rates are all inclusive.

Years of Experience *

Shift Preference *

The shift you prefer to work.

Alternate Shift *

Another shift you are willing to work if your preferred shift is not available.

Max Travel Distance *

The maximum distance you are willing to travel.

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.

Address *

Address Line 1

City

State

Zip Code

To Finalize Your Application, Call Us At 423-443-3233, To Speak With A Recruiter. *

Call us at 423-443-3233 after submitting this application. Our hours, M-TH: 9am-5pm.

I Agree *

By checking this box, I authorize AMS and Facility to verify information provided as a part of the application process.

Text (SMS) Opt-In *

By submitting, you authorize Assist Medical Staffing to send text messages related to job offers and other contract job information. Message/data rates apply. Consent is not a condition of employment. www.assistmedicalstaffing.com/terms-of-use

I Agree *

I will need to speak with a recruiter over the phone before my application is submitted to the hiring facility. Call us: 423-443-3233

Message