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Full Application

Personal Information



Work History 1

Past Employent
(Please list all permanent full-time or part-time, local agency, and/or travel assignments below)

Work History 2

Work History 3

Certification / Expiration

Certification / Expiration

Certification / Expiration


Select states with current license

Employee Profile

Application Certification


I certify that all statements made in this application are true to the best of my knowledge. I understand that all falsification or misleading information given in my application may result in the termination of my employment with Marvel Medical Staffing. Furthermore, I understand that my professional conduct and clinical performance is directly related to my ability to be placed on assignments for Marvel Medical Staffing and that I will adhere to all expectations set forth in the employee handbook. I authorization Marvel Medical Staffing 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 Marvel Medical Staffing or its clients. Furthermore, I understand that in the event of my employment, it is "at will" and Marvel Medical Staffing or I may terminate my employment at any time with or without notice and with or without case.

* I acknowledge that I will be legally obligated by the terms of this document by typing my name, which will constitute my signature in the provided space and electronically transmitting this document to Marvel Medical Staffing. I agree that Marvel Medical Staffing and I may use electronic means to conduct this transaction and that this document shall be governed and construed by the laws of the State of Nebraska.