work@cwsstaffing.com888-896-0522ALREADY REGISTERED? HOMEABOUT USFACILITIESEMPLOYEECONTACT US We are Real People, Providing Real Solutions.CWS Employee ApplicationStep 1 of 250%Personal Information:Name(Required) First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Enter Email Confirm Email Social Security Number:(Required)Date of Birth:(Required) Are you legally authorized to work in the United States?(Required) Yes NoProfessional Information:License/Certification Number:(Required)License/Certification Type:(Required)Expiration Date:(Required) State of Issuance:(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Enter your education information.Highest Degree Earned:(Required)School/Institution:(Required)Graduation Year:(Required)List your previous healthcare-related positions, including:Job Title(Required)Employer(Required)Start Date:(Required) End Date:(Required) Brief Description of Duties:(Required)Enter Preferred Work Settings:Preferred Work Settings:(Required) Hospitals Nursing Homes Home Health Care Clinics OtherShift Preferences:(Required) Day Shift Night Shift Rotating Shift OtherPreferred Work Schedule:(Required) Full-time Part-time PRNAre you willing to travel for assignments?(Required) Yes NoGeographic Preferences (List preferred cities or regions):List any special skills, certifications, or specialties.List any special skills, certifications, or specialties (e.g., ICU, ER, Pediatrics) that you possess:(Required)What is your desired hourly wage or salary for the positions you are applying for?(Required)Provide at least two professional references:Reference 1 Name(Required) First Last Relationship to Applicant:(Required)Phone(Required)Email(Required) Reference 2 Name(Required) First Last Relationship to Applicant:(Required)Phone(Required)Email(Required) Are you willing to undergo a background check and drug screening as part of the hiring process?(Required) Yes NoDo you have any physical or medical conditions that may affect your ability to perform healthcare duties?(Required) Yes NoIf yes, please provide details:Upload Resume Below:Upload Resume: Drop files here or Select filesMax. file size: 256 MB.I certify that the information provided on this application is accurate and complete. I understand that any misrepresentation or omission may result in disqualification from employment or termination if hired.Signature(Required)Your NameYour NameYour NameYour NameDate
