When you complete the form below, a member of our recruitment team will contact you by the next business day to help you find the best travel nursing jobs in the nation. Your information is kept strictly confidential and will not be shared with any outside party.

What is Important to You? What is Most Important to You When Selecting a Travel Assignment Money Location Length of Assignment How Many Hours Do You Want to Work 36 40 48 48+ How Long of an Assignment Do You Want Any 4 weeks 8 weeks 13+ weeks Strike Are there any other reasons that motivate you to become a traveler? Shift Preferences Shift Preference Day Evening Night Any Location Preferences Where Do You Want to Go Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Do you have a specific location in mind? Where?

Work Experience *Specialty Please Select Ambulance Transport Burn Unit Card Vas ICU Card Vas OR Cardiac Care Unit Cardiac ICU Case Manager Cath Lab Dialysis Director ER-Peds Electophysiology Emergency Room Endoscopy Float Float Acute GI Lab Gastro-Intestinal Geriatrics Hemo Dialysis Home Health Hospice House Supervisor IV Therapy Infection Control Intensive Care Unit Labor & Delivery Long Term Care Manager Maternity Med ICU Medical Surgical Mother/Baby Neonatal ICU Nephrology Neurology Neurosurgery Nursery OR Circulating OR Scrub Obetetrics and Gynecology Obstetrics Occupational Health Oncology Oncology-Peds Operating Room Orthopedics Other Pediatrics Peds ICU Perinatal Post Op Post Partum Pre/Post Cath Progressive Care Unit Psychiatirc Care-Chi Psychiatric Psychiatric Care -Ad Quality Assurance Radiology Recovery Room Rehab Renal Risk Management Same Day Surgery Step Down Sub Acute Care Unit Telemetry Transitional Care Unit Transplant Transport Trauma Triage Urgent Care Urology Utilization Review If other, please describe *Length of professional experience Please Select New Grad 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years or more *Have you ever worked as a travel nurse?  Yes  No *Have you ever applied with us before?  Yes  No

Contact Information On Assignment maintains a strict privacy policy. We will not share your information with any third party without your authorization and will only contact you for the specific purpose of serving your request. *First name *Last name *Phone Email NOTE: For security purposes, this must be a private email address. Your time zone Please Select Eastern Central Mountain Pacific Comments