Nurses Direct - LPN application

Nurses Direct currently has agreements to provide contract nurses to medical facilities. These facilities require basic information about the nurses who perform services at their facilities. In an effort to provide better services to both the contract nurses and facilities, Nurses Direct has assembled the information required by various facilities in this enclosed application.If you wish to contract your services through Nurses Direct, please fill out the application. We will in turn forward this information to any facility you choose to work with. Please advise our staff of your available shift times and areas/departments of preference.Thank you for choosing Nurses Direct. If you have any questions, please contact our office at 337-289-5393.

Drivers License, Social Security Card, LPN/CNA license (RN verified online), Current certifications: BLS, ACLS, PALS, NALS, CPI, Current TB/PPD test or Chest X-ray, Current Vaccines: Hep B, MMR, Tetanus, Flu, Copy of Respiratory Fit Test

Must be completed, true, and accurate. This information may, upon request, be furnished to those facilities which receive services from an employee nurses. (Begin work history with most recent)

Please list all post high school education.

Please complete the online Direct Deposit form located on NursesDirectLLC.com. All payments by Nurses Direct to employee will be made via direct deposit.

Please complete the online criminal background check. (background check is required before employment)

Please complete the online 2nd injury questionnaire form. (Required to be covered by Workman’s comp insurance in the event you get injured on the job)

In accordance with the privacy regulations promulgated under the Health Insurance Portability and Accountability Act, 45 (fort-five) CFR parts 160 and 164 (the "Privacy Regulations"), Nurses Direct LLC and Nurse Employee understand and agree to abide by the facility privacy policies and to not use or further disclose a patient's personal health information except as expressly permitted by the agreement or as otherwise authorized in writing by the patient through a consent or authorization meeting the requirements of the privacy regulations. NURSES DIRECT LLC and NURSE EMPLOYEE may only use a patient's personal health information for the sole purpose of treatment, and/or health care operations and may not release any information to unauthorized parties. NURSES DIRECT LLC and NURSE EMPLOYEE agree to implement appropriate safeguards to prevent the unauthorized use and disclosure of any patient's personal health information received by facility under this agreement. In addition NURSES DIRECT LLC and NURSE EMPLOYEE shall make available to the facility the protected health information for amendment purposes, should changes to the information be necessary or to provide an accounting of disclosure of the protected health information. If any unauthorized disclosure of personal health information occurs, NURSES DIRECT LLC and NURSE EMPLOYEE shall immediately contact facility to inform them of the disclosure and any remedial action taken to prevent further disclosures NURSES DIRECT LLC and NURSE EMPLOYEE understand that any unauthorized disclosure of a patient's personal health information is grounds for immediate termination of the agreement and/or staffing assignment.

You have the right to confidentiality - that means that the information given by you will not be released without your written consent, except to facilities in which you have or will work. We do not discriminate in the delivery of services. This means you will not be treated differently from others because of race, color, sex, age, disability, religion, nation origin, or political beliefs. This gives Nurses Direct permission to release any contracted facility the employee's credentials, including, but not limited to: background check, health screening, certifications and/or license, etc

I understand that due to my occupational exposure to blood and other potentially infectious materials I may be at risk of acquiring an infectious disease. I have been given the opportunity to be vaccinated a physician or facility of my choice at my own expense. If I have already received the vaccines or plan to receive in the future, I agree to provide documentation to verify to NURSES DIRECT if I will continue my services through NURSES DIRECT as an employee.I understand that by declining these vaccines, I continue to be at risk of acquiring an infectious disease. If in the future I continue to have occupational exposure to blood or other infectious materials and I want to be vaccinated, I can receive this vaccination series from the physician or facility of my choice at my own expense. I hereby agree to decline or provide documentation for the following vaccines: