If you would like to apply with us electronically, please complete the questionnaire below and it will be submitted to a staffing supervisor. Please send us a copy of your resume as well.
How did you hear about On-Site Medical Staffing?

If other, where?:
Name: 
Phone:    Pager:Alt Phone:
City:    State: 
E-mail: 
What job are you applying for?
  Years of Experience:
Best time to reach you:
Do you have:
Reliable transportation?  Yes No 
Your I-9 information?  Yes No 
Are you 18 years of age or older?  Yes No 
Are you willing to take a drug screen?  Yes No 
Are you available to work first shift?  Yes No 
Are you available to work second shift?  Yes No 
Are you available to work third shift?  Yes No 
What pay rate/range is acceptable to you? 

Have you ever been convicted of a felony?Yes No

If yes, please complete the following questions.
What Year? 
What was it for?
Would you release your criminal records?Yes No

 

On-Site Medical Staffing 

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Please call us:
Fort Wayne, IN (260)434-1981
Toll Free (888) 711-9083

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