Application form




8, 10, 12 Hour Shifts, Days/Evenings/Rotating Weekends

Previous Experience Required

Must be credentialed and approved for privileges through the established Medical Staff Committees initially and on an ongoing basis.

Specialized or Technical Education Required

Licensed in the State of Louisiana as an Advanced Practice Registered Nurse. Maintenance of DEA license is required.

Manual or Physical Skill Required

Physical Effort Required

Must possess good physical health. Required to stand for long periods of time. Lifting and transporting of patients is required. Motor coordination and manual dexterity are necessary. Strength: Light; Push: Occasionally; Pull: Occasionally; Carry: Occasionally; Lift: Occasionally; Sit: Frequently; Stand: Frequently; Walk: Frequently


Personal Information

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Referral Information

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Placement Information

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High School

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Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

Previous Employer 1

Previous Employer 2


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Reference 1

Reference 2

Reference 3

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