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Home
Services
- Employers
- Job Seekers
About Us
Contact

(301) 928-5872Call Now – Get Hired!

Candidate Intake

TheraHaven — Candidate Intake Form

theraHaven

Healthcare Staffing & Consulting

Candidate intake form
(301) 928-5872
therahaven.org

Tell us about yourself and your ideal placement. A TheraHaven recruiter will follow up within 24 hours to discuss opportunities that match your profile.

Please fill in all required fields before submitting.

Personal information

First name *

Last name *

Email *

Phone *

City

State *

Licensure

License type *

License number *

License state *

Expiration date *

Compact license?

Yes No Pending

Compact license significantly expands remote placement opportunities.

Additional states licensed

Clinical experience

Years of experience *

Highest education

Primary specialties *

Med-Surg ICU/Critical Care ER/ED Labor & Delivery Telemetry Pediatrics Oncology OR/Surgical Case Management Utilization Review CDI Telehealth Home Health Ambulatory/Clinic

EHR experience

Epic Cerner/Oracle Health Meditech Allscripts PointClickCare Other

Epic super user or build experience?

Yes No

Certifications (BLS, ACLS, CCM, etc.)

Placement preferences

Placement type *

Travel/Contract Remote Per Diem Temp-to-Perm Direct Hire

Available start date

Desired hourly rate ($)

Preferred locations

Open to relocation for travel?

Yes No Regional only

Shift preference

Days Evenings Nights Flexible

Credentials & compliance

Background check on file?

Yes No

Immunization records available?

Yes No Partial

Reference 1 — name, title, contact *

Reference 2 — name, title, contact *

Resume / CV link or file name

Final notes

Anything else we should know?

How did you hear about TheraHaven?

By submitting this form you agree to be contacted by TheraHaven LLC regarding placement opportunities. Your information is kept strictly confidential.

Application received

Thank you for applying with TheraHaven. A recruiter will reach out within 24 hours to discuss opportunities that match your profile.

(301) 928-5872 | therahaven.org

About Us

At TheraHaven, we specialize in providing top-tier staffing solutions tailored to meet the diverse needs of healthcare organizations.

Contact Us

(301) 928-5872

info@therahaven.org

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