Name:

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* 1. Name:

Email:

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* 2. Email:

What type of work or projects are you interested in?

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* 3. What type of work or projects are you interested in?

Are you a veteran?

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* 4. Are you a veteran?

Desired time commitment:

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* 5. Desired time commitment:

Practice/Specialty

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* 6. Practice/Specialty

RN License Number:

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* 7. RN License Number:

Highest level of education:

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* 8. Highest level of education:

Universities/colleges attended:

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* 9. Universities/colleges attended:

Do you belong to any professional nursing organizations? If so, please specify.

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* 10. Do you belong to any professional nursing organizations? If so, please specify.

List of past professional roles, including job title and name of the organization:

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* 11. List of past professional roles, including job title and name of the organization:

List your unique skills (bilingual, bicultural, math skills, prior teaching, nursing practice, etc.):

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* 12. List your unique skills (bilingual, bicultural, math skills, prior teaching, nursing practice, etc.):

Comments:

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* 13. Comments:

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