Advanced Registered Nurse Practioner Providing Company Nurse Staffing Recruitment Company
Independent Nurse Contractor   


Print/mail/fax an Application


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Nurse Application

     Note:  1) All The Fields marked in blue are compulsory Fields.
2) If you do not have an Email address, an Email address will be assigned to you as
First Name :
Middle Name :
Last Name :
Email :  (This will be username for this site)
Password :  (create password to be used on this site)
Re-Type Password :
Home Address1 :
Home Address2 :
Home City :
Home State :
Home Zip :
Home Country :
Home County :
Home Phone : (999-999-9999)
Pager :
Cell :
Work Phone : (999-999-9999)
Emergency Contact Phone : (999-999-9999)
Emergency Contact Name :
Nurse Type :
Referral Source :
Other Referral :
Questions and Comments :
Birth Date : (mm/dd/yyyy)
Experience Yr :
Specialty1 :
Specialty2 :
Specialty3 :
Other Specialty :
Work Area Preference :
Other Work area :
Shift Preference :
Whether Applied earlier with SNI :
If Yes When :
Applied Date :
(Enter the letters as they are shown in the image above.)
Please note: We will contact you within 72 hours to review your clinical experience. If you meet the requirements, we will arrange for a clinical interview.

Please plan to bring the following items with you:

  •   The signed display portion of your current nursing license (s)
  • A current resume or curriculum vitae
  • Proof of current independent malpractice insurance coverage (As an independent contractor, if you do not currently have independent malpractice coverage, you will be required to obtain coverage's of 1mllion/6million prior to working a shift)
  • Proof of current PPD and Vaccinations (or Titer) records
  • A copy of your current Drivers License
  • A copy of your current PA Child Abuse Clearance (if applicable)
  • A check or money order in the amount of $10.00, made out to SNI. This is to process a current Criminal Record Check
  • Proof of current CPR, BCLS, ACLS, NALS, or any other related certifications.

Thank you for applying to work as an SNI Nurse Contractor. Please click "submit" to send this application now. You can reach our Nurse Recruiter directly by calling 1-800-284-4764 or via email


JCAHO Certified Advanced Registered Nurse Practitioner