Address: 7620 N Hartman Ln Ste 112, TUCSON, AZ, 85743, US
Telephone: (520)442-2411

Act Now DME Application

PLEASE OPEN THIS PAGE IN CHROME, INTERNET EXPLORER, OR SAFARI
Thank you for choosing Act Now DME:

Healthcare professionals are always in high demand. We know you have a choice in employment and we are happy you have decided to join Act Now DME.

Act Now DME is RN owned and operated.

Our company allows for employees to enjoy a safe work environment with flexibility and a meaningful and rewarding job experience. As a healthcare professional, you make the difference – between life and death, comfort and pain, knowledge and fear, freedom and dependence. Imagine having that feeling every day. Working in the healthcare field is a noble profession. Here at Act Now DME understand what it is to work with and care for patients. We are here to assist you and give to you in all of your pursuits.

Act Now DME knows that all healthcare workers are overworked and under-appreciated but “we are the helping hands of healthcare.” We value and care about all those who come through our doors. We want for all those in healthcare careers to have a better life: one with great autonomy, financial compensation and have the ability to be independent and happy in your practice as a healthcare worker.

Act Now DME is on the forefront of technology, allowing you to see your payroll on-line, up-to-date schedule, and complete all charting from a computer. Our website allows you to input your information and availability when it is convenient for you 24 hours a day. We will not contact you on the days that you show you are not available for shifts.

We are focused on service to you and community development both locally and nationally. There are many benefits that we would like to share with you.

Sincerely:
The Act Now DME Staff
Office: (520)442-2411
Email: hr@actnowd1.sg-host.com

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Employee Information
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Applying For:*

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Education
Type of Degree / Certification (Check One)*
If Other, Please List Degree / Certification Here:
Professional License/ Technical Certificate
State License Exp. Date
Special Certications (Include Expiration Dates)*
CPR/BLS ACLS Pals Other
Education/CEU*
School Name-Location Program Years Graduate (Y/N) Degree
Experience
Previous Expierence
- Acute
- Ambulatory Care
- Ambulatory Serivces
Age Specific Competencies
- Neonates / Newborns (BIRTH – 30 Days)
- Infants (30 Days – 1 Year)
- Toddlers (1 – 3 Years)
- Preschooler (3 – 5 Years)
- Older Children (5 – 12 Years)
- Adolescent (12 – 18 Years)
- Younger Adult (18 – 40 Years)
- Middle Adult (40 – 64 Years)
- Older Adults / Geriatrics (64+ Years)

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LIST YOUR LAST THREE (3) EMPLOYERS BEGINNING WITH YOUR MOST RECENT EMPLOYER.
Resumes are accepted but do not replace your application.
Current or Most Recent Employer:
Company Name*
Position/Title Held*
Start Date*
Month
Day
Year
End Date*
Supervisor Contact Information*
Name Email Phone Number
Rate of Pay
Reason For Leaving*
Employer Two:
Company Name*
Position/Title Held*
Start Date*
Month
Day
Year
End Date*
Month
Day
Year
Supervisor Contact Information*
Name Email Phone Number
Rate of Pay
Reason For Leaving*
Employer Three:
Company Name*
Position/Title Held*
Start Date*
Month
Day
Year
End Date*
Month
Day
Year
Supervisor Contact Information*
Name Email Phone Number
Rate of Pay
Reason For Leaving*
Professional References
Please add a minimum of three references.
*
Name Relationship Email Phone Number Years Known

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Notification & Agreement
Note: You must agree to ALL fields below to complete your application.
I certify that all answers and statements I have made on this application (and any other accompanying or required documents) are true and complete without omissions. I understand that any falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.*
- Yes
- No
I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between Act Now DME or myself for employment for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current written agreement signed by the President or Vice President*
- Yes
- No
I hereby authorize any of the persons of organizations named in the application (or other accompanying or required documents) to give you complete information and records regarding my employment, education, character and qualifications. This application is valid for only ninety (90) days from the date signed. If I want to be considered for job openings more than ninety (90) days from date signed, I will submit a new application.*
- Yes
- No
Applicant Signature*
Print Complete Name*
Date Signed*
Month
Day
Year

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Please Upload Your Professional Resume/CV Below:
Please note: If you do not have any of these files immediately available, please send any requested documents to hr@actnowd1.sg-host.com, This WILL delay the processing of your application.
File
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg, Max. file size: 256 MB.
Captcha
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Act Now DME Application

Step 1 of 7

Act Now DME Application

PLEASE OPEN THIS PAGE IN CHROME, INTERNET EXPLORER, OR SAFARI

Employee Information

Education

Experience

Additional Information

LIST YOUR LAST THREE (3) EMPLOYERS BEGINNING WITH YOUR MOST RECENT EMPLOYER.

Current or Most Recent Employer:

Employer Two:

Employer Three:

Professional References

Notification & Agreement

Please Upload Your Professional Resume/CV Below:

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Services

Information

Affiliations

State	License	Exp. Date

School Name-Location	Program	Years	Graduate (Y/N)	Degree

Name	Relationship	Email	Phone Number	Years Known