Apply for Nurse Practitioner - Potomac Management Solutions

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Apply for Nurse Practitioner

Please create an applicant profile by providing information as requested below and attach your resume for consideration.

NOTICE: Submission of your resume does "NOT" constitute completion of an employment application. If selected to participate in an interview and proceed with processing, you will be contacted by a member of our staffing team and asked to complete an application at that time.

Fields with an asterisk (*) are required.

Summary
Title:	Nurse Practitioner
ID:	2772 IOWA
City:	N/A
State:	Iowa

Resume
* Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

	- or Upload from:


Contact Information
* First Name:
* Last Name:
Address:
City:
State:
Zip:
* Phone:
* Email:
Application Information
Current Clearance Held:
Desired Salary:
How did you hear of us?:

Voluntary Self-Identification of Disability CC-305

Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 01/31/2020

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.ⁱ To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Blindness
Deafness
Cancer
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Epilepsy

Autism
Cerebal palsy
HIV/AIDS
Schizophrenia
Muscular dystrophy

Bipolar disorder
Major depression
Multiple sclerosis (MS)
Missing limbs or partially missing limbs

Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)

Please select one of the options below:

* Do you have a disability

* Your Name

* Today's Date

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

ⁱ Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Applicant Letter of Intent

* I hereby grant permission to submit my name and resume as a candidate for the position noted above. I further confirm my interest in employment, should I be selected for this position, meet the necessary clearance requirements and conditions of employment.

	Yes
	No

JCC NP Attachment Request

* A copy of your active licensure is needed. Please confirm you have uploaded a copy of your licensure.

	Yes
	No

* A copy of your active DEA Registration is needed. Please confirm you have uploaded a copy of your DEA Registration.

	Yes
	No

Experience Working with Adolecents

* Do you have 1 year or more of experience working with Adolescents?

	Yes
	No

* How many years of experience working with adolescents to you have?

	Less than 1 year
	1-5 years
	5+ years
	I have no experience working with adolescents.

* Please sign Statement of Experience:

MSEP Questionnaire

Please complete.

Military spouse data is 100% anonymous and collected in support of outreach and hiring military spouses for our positions nationwide. Potomac Management Solutions, LLC (PMS) values the military spouse community and all that they do in support of our troops. PMS is a proud member of the Military Spouse Employment Partnership.

* Are you an Active Duty, National Guard or Reserve Military Spouse?

	Yes
	No

If Yes, in which branch of the military does your spouse serve?

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

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	American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South American (including Central America), and who maintains tribal affiliation or community attachment.
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	Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
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	Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

	NOT a Veteran (Non Applicable) - A person who has not served in the armed forces.
	Disabled Veteran - A veteran of the U.S. Military ground, naval or air service who is entitled to compensation (or who, but for the receipt of military retire pay, would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or - A person who was discharged or released from active duty because of a service connected disability.
	Armed Forces Service Medal Veteran - A veteran who, while serving on active duty in the U.S Military ground, naval, or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
	Other Protected Veteran - A veteran who served on active duty in the U.S. Military during a war or in a campaign or expedition for which a campaign badge is awarded.
	Recently Separated Veteran- within last 3 years - A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. Military ground, naval or air service.