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Are you willing to submit to a drug screen?*
Are you willing to submit to a criminal background check?*
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Previous Employment
(List all permanent full-time or part-time, local agency, and/or travel assignments below)

To the best of my knowledge, I certify that all statements made in this application are true and correct. I understand that all falsification or misleading information given in my application may result in the termination of my employment with Resurgence Healthcare Solutions. Furthermore, I understand that my professional conduct and clinical performance is directly related to my ability to be placed on assignments for Resurgence Healthcare Solutions and that I will adhere to all expectations set forth in the employee handbook. I authorize Resurgence Healthcare Solutions to verify the information I have provided, to contact references, and to conduct a criminal background check concerning my qualifications and past employment record. I understand that nothing contained in this application is intended to create an employment contract, either verbal or written, with Resurgence Healthcare Solutions or its clients. Furthermore, I understand that in the event of my employment, it is "at will" and Resurgence Healthcare Solutions or I may terminate my employment at any time with or without notice and with or without case.

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