Application ConTemporary Nursing Solutions, Inc. Name* First Last Professional License*RNLPNNPState of LicenseClinical Specialty with 2 years experience in last 4 (example, ICU, ER, MS, etc.)*Please upload your ResumeEmail* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security #Date of Birth~I am able to perform all essential functions of the position for which I am applying. ~I have never been convicted of a felony. ~ My clinical license has never been suspended ~I understand that any misrepresentation, falsification or material omission in this application will result in my failure to receive an offer for employment or my immediate dismissal. ~I authorize ConTemporary to contact prior employers. I release all parties and persons from liability that may result from furnishing information. ~I agree that if I am hired, my employment with CTS can be terminated at will, with or without cause, with or without notice at any time.*I AgreeElectronic Signature - please type your complete name below:*Date*