Phone (888) 852-2440 or (423) 454-4388
Fax (423) 702-6591
info@resultsmedicalstaffing.com

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Thank you for completing this form. We look forward to helping you. A Results team member will contact you if your skill set and background are a possible match with one of our clients. If you want to email your resume, please click HERE. You can also fax your resume to (423) 702-6591. Your inquiry will remain confidential.  

Name:
Street Address:
Cell Phone:
Home Phone:
City:
State:
Zip:
Email:
Position Interested In:
Geographic Preference:
Preferred Setting or Patient Type:
Additional Comments
(hobbies, interest, anything you want - we just want to know more about you):
If available, please email your resume by clicking HERE or fax to (423) 702-6591.
How did you hear about us?
Salary / Wage Expectations:
Days and times available to work:
When are you available to start?
Please list educational institutions attended and degree(s) earned. What year?
Have you ever been convicted of a crime?  If yes, please explain number of convictions, nature of offense leading to conviction, how recently such offenses were committed, sentence imposed, type of rehabiliation:
Work History
​If your resume already includes this information, you DO NOT have to complete this section.
Name of Company / Position Held / Employment Dates / Salary / Reason for leaving or considering to leave / Duties while in this position
Name of Company / Position Held / Employment Dates / Salary / Reason for leaving or considering to leave / Duties while in this position
Name of Company / Position Held / Employment Dates / Salary / Reason for leaving or considering to leave / Duties while in this position
Please list any other skills or certifications:
References
Please list 3 professional references.  If you have already listed references elsewhere in this process to Results Medical, you DO NOT have to complete this section.
Reference Name / Their Position / Company / Telephone #1 / Telephone #2 / Email Address
Reference Name / Their Position / Company / Telephone #1 / Telephone #2 / Email Address
Reference Name / Their Position / Company / Telephone #1 / Telephone #2 / Email Address
EQUAL EMPLOYMENT OPPORTUNITY 
Results Medical Staffing is committed to equal employment opportunity in all of its employment practices. Decisions involving every aspect of the employment relationship are made without regard to an employee's race, color, creed, religion, sex, age, national origin, marital status, veteran status, workers' compensation, disability, or any other status or characteristic protected under applicable state or federal law, unless it is a bonafide occupational requirement necessary to the normal operation of the business.

NOTIFICATION AND AGREEMENT
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK THEM BEFORE SIGNING. YOUR APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECEIPT DOES NOT IMPLY YOU WILL BE EMPLOYED.

I certify that all answers and statements I have made on this application (and any other accompanying or required documents) are true and complete without omissions. I understand that any falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

I acknowledge that I have read, understand, and agree with the above. In addition, I hereby authorize any of the persons of organizations named in the application (or other accompanying or required documents) to give you complete information and records regarding my employment, education, character and qualifications.

Please enter your NAME and DATE in the space to the right before clicking SUBMIT to formally send us your application.
Is there a setting or patient population you absolutely want to avoid?