Please fill out the form below, or if you prefer, you may download a copy and fax it to 435-529-4088.

Employment Application
Thank you for your interest in Advantage Medical Staffing. It is important to read the following information before filling out the employment application. When your application is complete and submitted,

Background investigation policy
Advantage Medical Staffing will conduct a background investigation on all new hires and re-hires. Employment is contingent upon a signed release form to obtain an investigative consumer report and a satisfactory report. Any derogatory information revealed from a background investigation will be taken into consideration along with all other information known about the applicant. A case-by-case determination will be made regarding the applicant's suitability for employment.

Drug Free Policy
Advantage Medical Staffing believes that employees should work in an environment as free from the use of non-prescribed drugs and alcohol as reasonably possible. Due to easy access of controlled substances in the healthcare setting and potential risks to patients and colleagues, the agency prohibits any involvement by our employees with illegal drugs or alcohol or reporting to work under the influence of drugs or alcohol. It is our policy to test any employee upon hire and at any time for just-cause.

Harassment and workplace violence
All of our colleagues have the right to work in an environment free of harassment and disruptive behavior. We will not tolerate harassment by anyone based on the diverse characteristics or cultural backgrounds of those who work with us. Degrading or humiliating jokes, slurs, intimidations, or other harassing conduct is not acceptable in the work place. Sexual harassment is prohibited and is grounds for termination. This may include, but is not limited to physical or verbal behavior of a sexual nature that causes intimidation of another person. Incidences of violence, stalking, theft, or hate crimes will not be tolerated, and should be reported when observed or experienced by any current or former employee.

Application For Employment
Advantage Medical Staffing
372 West 100 North
Salina, Utah 84654
Toll-free: 866-529-4077
Fax: 435-529-4088

Your Name:
Are you at least 18 yrs old?	Yes:   No:
Telephone(s):
E-mail:
Address:
City, State, Zip:
Position Applying For:
Are you interested in full- or part-time? Select one or both:	Full-Time Part-Time
Do you want long term or daily assignments? Select one or both:	Long-Term Part-Time
How many hour per week?
Shifts available to work? Select any or all:	Days Nights Weekends
Date available to begin:
Education/Degrees/Certifications	LPN RN Other
Please list pertinent degrees, certifications, or training:
Employment History Position #1
Company:
Supervisor's name:
Address:
Phone:
Dates of employment:	From:   To:
May we contact them?	Yes:   No:
Salary upon leaving:
Reason for leaving:
Experience/Training received while there:
Position #2
Company:
Supervisor's name:
Address:
Phone:
Dates of employment:	From:   To:
May we contact them?	Yes:   No:
Salary upon leaving:
Reason for leaving:
Experience/Training received while there:
Position #3
Company:
Supervisor’s name:
Address:
Phone:
Dates of employment:	From:   To:
May we contact them?	Yes:   No:
Salary upon leaving:
Reason for leaving:
Experience/Training received while there:
Personal References with phone number (Please use those who have personal knowledge of your work):
Your Questions or Comments?

For a Nurse Recruiter, or company information, call:

Telephone: 435-529-4077
Toll Free: 1-866-529-4077
Fax: 435-529-4088
E-mail Advantage Medical Staffing to get medical staffing now!