Education History:
License / Certification:
Work History/Reference (2 Are Required)
This helps us to match you more quickly to the assignments you want, and gives you a leg up over others interested in the same assignments, which often fill quickly.
1. Please complete and submit contact information for two of your most recent supervisors and/or managers who previously supervised you in a clinical work setting.
*** PLEASE NOTE: (*Peer references are not applicable)
Acceptable reference contacts include present or former supervisors, managers, team leads, charge personnel or other titles of individuals who previously supervised you.
2. A valid PHONE NUMBER or EMAIL ADDRESS for your reference contact is required.
# 1 Work History / Reference
# 2 Work History / Reference
If yes please explain below:
If Yes please explain below:
Please Note:
Before Submitting This Application, You Must Agree To The Following Terms And Conditions.
I attest that the information provided in this application is complete and accurate, to the best of my knowledge. Providing incomplete or inaccurate information may result in disqualification from possible employment with THI STAFFING INC, and may be a violation of state law(s) that could result in civil penalties.
I understand that THI STAFFING INC, certain states and/or client institutions require pre-placement assessments such as criminal background checks, drug screenings and clinical knowledge tests. I further understand prior to conducting any background checks that qualify as consumer or investigative consumer reports, I will be provided and will return, separate disclosure and acknowledgement forms as required by THI STAFFING INC.
I authorize THI STAFFING INC to investigate any and all statements contained herein and request the persons, firms, and/or corporations named above to answer any and all questions relating to this application. I HEREBY RELEASE all parties from liability, including but not limited to, the employer and any person, firm or corporation who provides information concerning my prior education, employment or character.
Electronic Signature Statement: I agree that inserting my personal information above and my initials below represents my signature.
Privacy Disclaimer
T.H.I will never disclose any information collected by the Site to any third party except as required by a valid legal process such as a search warrant, subpoena, statute, or court order ("Legal Process"). Information collected through your use of the Site is for the sole purpose of facilitating or improving our business relationship with you.
