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Moore Nurses Registration
Moore Nurses Registration
1. Contact & Registration
Name
*
First
Last
Email
*
Phone
*
Home Address, Apt #, State & Zip
*
Date of Birth
*
Last 4 # of Social Security Number
*
Hidden
Covid-19 Vaccination Card: If you have a Covid-19 card, please upload a copy now.
Accepted file types: pdf, doc, docx, jpg, jpeg, png, tiff, Max. file size: 2 MB.
Specialty Applying For:
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ICU
Tele
Med-Surg/Tele
L&D
NICU
PACU
PP
OR
ER
Pedi
PICU
Step-Down
CVICU
CVOR
CATH LAB
2. RN License(s)
List all active State RN License(s) & Expiration Date(s). Example: Texas 123456 01/01/2024
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Please list your (AHA) Heart Cards & certifications with expiration dates.
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RN License Information
3. Resume / Work History & Education
Please select how you would like to submit your last seven (7) years work history and education. *IMPORTANT* you must provide the Start & End Month and Year for each position provided. If you submit your resume please ensure the dates are included.
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I have a current copy. I will attach it.
I need to fill one out.
*IMPORTANT* you must provide the Start & End Month and Year for each position provided. If you submit your resume please ensure the dates are included.
Please attach your Resume or Work History & Education Form below.
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, tiff, Max. file size: 2 MB.
Please Click Next To Begin Online Work History And Education Form
Education
Name of School
*
Address
*
City
State / Province / Region
Degree Achieved
*
Graduated
MM slash DD slash YYYY
Education Continued
Name of School
Address
City
State / Province / Region
Degree Achieved
Graduated
MM slash DD slash YYYY
Work History
Please list your last 7 years work history. You must include the start and end date of employment. You only need to be accurate to the Month & Year. If you are currently employed put today's date as the Date End Employed.
Employment 1
Date Started Employment
*
MM slash DD slash YYYY
Date End Employment
*
MM slash DD slash YYYY
Employer Name
*
Position & Specialty
*
Location
*
City
State / Province / Region
Duties
Employment 2
Date Started Employment
MM slash DD slash YYYY
Date End Employment
MM slash DD slash YYYY
Employer Name
Position & Speciality
Location
City
State / Province / Region
Duties
Employment 3
Date Started Employment
MM slash DD slash YYYY
Date End Employment
MM slash DD slash YYYY
Employer Name
Position & Speciality
Location
City
State / Province / Region
Duties
Employment 4
Date Started Employment
MM slash DD slash YYYY
Date End Employment
MM slash DD slash YYYY
Employer Name
Position & Specialty
Location
City
State / Province / Region
Duties
Employment 5
Date Started Employment
MM slash DD slash YYYY
Date Ended Employment
MM slash DD slash YYYY
Employer Name
Position & Specialty
Location
City
State / Province / Region
Duties
Would you like to add more history?
*
Yes
No
Employment 6
Date Started Employment
MM slash DD slash YYYY
Date Ended Employment
MM slash DD slash YYYY
Employer Name
Position & Specialty
Location
City
State / Province / Region
Untitled
4. Professional Reference Form
Please provide a minimum of two (2) professional references in your specialty. References must cover twelve (12) months of work from your last thirty six (36) months of experience (hospital requirement). Include the Hospital Name you worked at with the reference.
You can provide your references by uploading a document or by filling in a web form. I would like to:
Provide my references via web form.
Upload a list of references
File
Accepted file types: pdf, doc, docx, jpg, Max. file size: 2 MB.
Reference 1
Reference Name
*
First
Last
Reference 's Unit/Title
*
Reference's Phone
*
Facility Name
*
Location
*
City
State / Province / Region
Position During Employment
*
Date Start Employed
*
MM slash DD slash YYYY
Date End Employed
*
MM slash DD slash YYYY
Reference 2
Reference Name
*
First
Last
Reference 's Unit/Title
*
Reference's Phone
*
Facility Name
*
Location
*
City
State / Province / Region
Position During Employment
*
Date Start Employed
*
MM slash DD slash YYYY
Date End Employed
*
MM slash DD slash YYYY
5. Pre-Qualification Application
3 Question Attestation
Can you submit verification of your legal right to work in the U.S.?
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Yes
No
Have you ever been named as a defendant in a professional liability claim?
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Yes
No
Comment:
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Has your professional license ever been investigated or suspended?
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Yes
No
Comment:
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Pre-Interview Questionnaire
Candidate Start/Availability Date:
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MM slash DD slash YYYY
Do you expect to need any time off during this assignment (Hospital max is 5 days)?
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Yes
No
Please specify the dates you'll need off
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Does Candidate have 3 months experience with computerized charting in the past year?
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Yes
No
Does Candidate have at least 1 year current experience in specialty in the past 3 years (**if you're applying for PACU/OR 2yrs current experience)?
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Yes
No
Is Candidate ok with floating?
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Yes
No
Can Candidate insert own IV's?
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Yes
No
General Questions
Shift Preference
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AM
PM
Either AM or PM
Do you have a preferred destination city or state?
List your recruiter with Moore Nurses or the person who referred you.
*
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If you are applying for a California position, have you applied for a position at a Kaiser Permanente hospital in the last six (6) months?
Yes
No
Hidden
Please list the date you applied, the name of the KP Hospital and if you did the Voice Advantage (VA) interview for the position.
Does Candidate have recent skills checklist on file?
Yes
No
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