Professional References

References help us match you more quickly to the assignments you want, and gives you a leg up over others interested in the same assignments, which often fill quickly. Please input up to three of your most recent supervisors and/or managers.

Completing Your References:

Please complete all required fields. A valid e-mail address for your reference contact is required as this form will be submitted to your reference. Acceptable reference contacts include: present or former supervisors, managers, team leads, charge personnel or other titles of individuals who currently supervise or previously supervised you in a work setting. Peer references are not applicable.

Your Profile
Please enter your full legal name as it appears on your Social Security Card.
* First name: * Last name:
* Email address:
You can submit up to 3 reference requests. To add another reference request, click on "Add Another". To submit your reference request(s), please click "submit" at the bottom of the page.

Your Reference Contact will receive an email to evaluate you. You will need to enter the email address and attest in order to complete your submission.

Reference No. 1
* Evaluator First name: * Evaluator Last name:
* Evaluator Email address: Evaluator Phone #:


 
* Evaluator Position Title: If Other, Please List:
Facility Profile
* Facility name:
* Facility city: * Facility state:
Unit Profile
* Unit/floor/dept name:
* Discipline: * Specialty:
* Unit description:
May include common patient diagnoses, patient acuity, special equipment used, special skills/competencies, etc.
* Your position held:
Dates employed: (To date not required if currently working)
* From: To:
(mm/dd/yyyy) (mm/dd/yyyy)
* Charge experience?:
Attestation
 
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided will result in being ineligible to travel with AMN Healthcare.
* *Date:

By clicking “SUBMIT” I agree to receive emails, automated text messages and phone calls (including calls that contain prerecorded content) from and on behalf of American Mobile, its parent, AMN Healthcare, and affiliates…