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Healthcare Professional Job Application – 3B Elite Healthcare Staffing

First Name

Last Name

Phone/Mobile

Address

Address Line

City

State

Zip Code

Country

Preferred Contact Method

Position Applying For

Specify Position (if Other selected)

Resume Upload (PDF or DOC)

Choose File

Years of Experience

Employment Type Preference

Travel Distance Willing to Accept Assignments

SPD Certification Status

File Upload

Choose File

RN License Upload

Choose File

Radiology License / ARRT Certification Upload

Choose File

BLS Certification Status

BLS Certification Card Upload

Choose File

PALS Certification Status

PALS Certification Card Upload

Choose File

ACLS Certification Status

ACLS Certification Card Upload

Choose File

NRP Certification Status

NRP Certification Card Upload

Choose File

Government ID / Driver’s License Upload

Choose File

Immunization & Health Clearance Information

Some healthcare facilities require immunization documentation before assignment placement. Please select your current status below.

TB Test Status (within last 12 months)

MMR Immunity Status (Measles, Mumps, Rubella)

Varicella Immunity Status (Chickenpox)

Hepatitis B Immunity Status

COVID-19 Vaccination Status

Are you legally authorized to work in the United States?

Yes

Will you now or in the future require employment visa sponsorship?

Yes

Professional References (optional but recommended)

Please provide at least one professional reference. Two references are preferred for hospital credentialing.

Reference First Name

Reference Last Name

Reference Title

Facility Name

Reference Phone Number

Reference Email

Would you like to add a second professional reference?

Yes

Reference First Name #2

Reference Last Name #2

Reference Title (Second Reference)

Facility Name (Second Reference)

Reference Phone Number (Second Reference)

Reference Email (Second Reference)

Compliance & Authorization

I certify that the information provided in this application is true, accurate, and complete to the best of my knowledge. I authorize 3B Elite Healthcare Staffing to verify my credentials, licensure status, employment history, and professional references as part of the credentialing process. I consent to be contacted regarding employment opportunities, credentialing requirements, and placement availability. I understand that submission of this application does not guarantee employment or assignment placement.

SMS Consent (Optional)

I agree to receive text messages from 3B Elite Healthcare Staffing regarding job opportunities, credentialing updates, and placement communications. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out.

Background Screening Authorization

I authorize 3B Elite Healthcare Staffing to conduct background screening, exclusion list checks (OIG/SAM), and credential verification as required by applicable regulations and client facility requirements.