Comprehensive Staffing Solutions of NYC

Competent, Caring, and Compassionate Therapists & Nurses

Fill out the online form below and click "Submit Application" to send your application to us. We'll get in touch with you to discuss your application. Alternatively, you may download the form, fill it out and fax it to (212) 566.8856.

Applicant Information

Full Name
Date
Address
City
State
Country
Zip Code
Phone
E-mail Address
Date Available
Social Security No.
Desired Salary $
Position Applied for
	Are you a citizen of the United States?
	If no, are you authorized to work in the U.S.?
	Have you ever worked for this company?
If yes, when?
	Have you ever been convicted of a felony?
If yes, explain:

Education

High School
Address
Country
From	To
Did you graduate?	Yes No
College
Address
Country
From	To
Did you graduate?	Yes No
Degree Received
Other
Address
Country
From	To
Did you graduate?	Yes No
Degree Received

References

Please list three professional references.
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address

Previous Emplyment

Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilites
From	To
Reason for Leaving
	May we contact your previous supervisor for reference?
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilites
From	To
Reason for Leaving
	May we contact your previous supervisor for reference?
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilites
From	To
Reason for Leaving
	May we contact your previous supervisor for reference?

Military Service

Branch
From	To
Rank at Discharge
Type of Discharge
If other than honorable, explain:
Type the two words: