Apply for our nursing jobs easily by filling out the form below. We’ll give you a call and help with all aspects of job placement. You can also check out all of our open positions by clicking the button to the right. Browse Job Listings Step 1 of 4 25% Name* First MI Last Maiden Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone #Cell Phone #Email Emergency Contact First Last Contact Phone Date Available* PositionPRN13 WeekReferred by:Have you worked for an agency before?*YesNoWhich company?*Can you, after employment, submit verification of your legal right to work in the United States?*YesNoAre you able to perform the basic functions of the position without reasonable accommodation?*YesNoPlease explain:*Have you ever been convicted of a crime that would prohibit your employment at a healthcare facility?*YesNoPlease Explain*Are you willing to submit to a criminal background investigation?*YesNoHave you ever had disciplinary action taken against any license, or are you currently under investigation?*YesNoPlease Explain:*As a condition of employment, you may be required to take and pass a drug and/or alcohol screen in any or all of the following circumstances: Pre-employment Post-accident For cause random selection Are you willing to submit to such tests?*YesNo EducationSchool*Major*Degree*SchoolMajorDegreeSpecialties (most current experience first)SpecialtyYears of ExperienceAs of SpecialtyYears of ExperienceAs of SpecialtyYears of ExperienceAs of SpecialtyYears of ExperienceAs of LicensureProfessional License #Expiration Date StateProfessional License #Expiration Date StateCertificationsYou must fax a copy of your file to 859.523.6802 or mail to 2452 Ogden Way | Lexington, KY 40509 .CertificationExpiration Date CertificationExpiration Date CertificationExpiration Date CertificationExpiration Date CertificationExpiration Date Employment HistoryList in order, most recent first.Job TitleEmployerFrom To Specialty/Unit# of BedsNurse to Patient RatioCharge ExperienceYesNoReason for LeavingAddressSupervisorBusiness Phone #May We Contact?YesNoJob TitleEmployerFrom To Specialty/Unit# of BedsNurse to Patient RatioCharge ExperienceYesNoReason for LeavingAddressSupervisorBusiness Phone #May We Contact?YesNoJob TitleEmployerFrom To Specialty/Unit# of BedsNurse to Patient RatioCharge ExperienceYesNoReason for LeavingAddressSupervisorBusiness Phone #May We Contact?YesNoBluegrass Healthcare Staffing is an Equal Opportunity Employer. All applicants are considered for employment regardless of age, race, gender, sexual orientation, religion, national origin, disability, marital status, or any other factor prohibited by law. I certify that the information provided on this application is accurate. I understand that the giving of false information on this application will result in a refusal to hire or disciplinary action up to and including termination. Furthermore, I grant permission to any person, firm, corporation, or educational institution to release to Bluegrass Healthcare Staffing, LLC. any and all information regarding my past employment, background, credit history, education, motor vehicle records and criminal records. I understand and agree that if I am offered employment by the company, it will be on an at-will basis. This means that either I or the company may terminate the employment relationship at any time, for any reason, with or without cause or notice. I also understand and agree that only an officer of the company can enter into an agreement on any other terms and he/she can only do so in writing signed by him/her and me. I have read the above before signing this application. I further understand and waive my right of privacy in this investigation and release and hold harmless Bluegrass Healthcare Staffing from any liability. I agree that any decision to hire me is contingent upon the results of my report, and certify that all statements and answers on my application, resume, or interview are true and complete to the best of my knowledge. I understand that if any statements are false or that if information has been omitted, this will be cause for disqualification and immediate termination of my employment. If employed, I further authorize Bluegrass Healthcare Staffing to check my credit and/or conviction record, as needed, on a continuous basis as it relates to my employment. I authorize Bluegrass Healthcare Staffing to release any employment records, including health records submitted to Bluegrass Healthcare Staffing to any customer of Bluegrass Healthcare Staffing for consideration of employment at customer facility. Consent* By typing my name below, I am electronically signing this applications and agree to the terms herein. Name* First Last Enter today's Date* PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.