Submit Your Application

Fill out some info and we will be in touch shortly! We can't wait to hear from you!

Note: If you’ve already filled out an inquiry form, you don’t need to re-enter the same information—just complete the missing fields below so we can get you submitted quickly!

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you already filled out the inquiry form?

Yes

Prefered Start Date

YYYY

Any dates you need to request off?

Specialty (e.g., ICU, ER, PICU, XRAY, RESP etc.)

Years of experience

Do you have travel experience?

Yes

Where are you licensed?

Why We Ask for Your SSN and Date of Birth

We understand that sharing your Social Security Number and Date of Birth can feel a bit personal, and we want you to know exactly why we request this information. As a travel nurse agency, we’re required to submit certain details to healthcare facilities in order to present you for job opportunities. Your SSN and DOB are used solely for credentialing and compliance purposes—such as verifying your licensure, conducting background checks, and ensuring you meet each facility’s specific requirements. We take your privacy seriously and use secure systems to protect your information. If you'd prefer not to submit your SSN or DOB online, no problem at all—we’re happy to collect that information over the phone instead. Just let us know what works best for you!

Professional References

Please provide at least two recent reference from someone you’ve worked with clinically—ideally a supervisor or charge nurse. We’ll need their name, title, phone number or email, and the facility or unit where you worked together. This helps us complete your submission and get you placed faster!

Can we thank someone for referring you?

Anything else that you would like us to know?

Submit Your Application

Travel Nursing USA

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