Name:
Address:
City, State, Zip:
Tel:
Best Time To Call:
E-mail:
Salary Requirements:
Desired Commute Time:
Do you have a car? No Yes
Access to public transportation? No Yes
Work Preferences
(choose all that apply)		 Temporary
Temp-To-Hire

I am looking for...
Computer Experience:
Work History (Briefly describe each position):
Other Helpful Information:
The information you provide here will only be used to match your qualifications with a job opportunity. There will never be a fee to you, the candidate, for our services and your name and number will not be given out.

The information you provide here will only be used to match your qualifications with a job opportunity. There will never be a fee to you, the candidate, for our services and your name and number will not be given out.
If you have a resume and would like to send it to us, please email it to clifton@theassurancegroup.com or fax it to Assurance at the following numbers:


Health Care Staffing: 201-712-0426

If you do not have a resume or would like us to call you first, simply fill out the above form or call us at the following numbers:

Health Care Staffing: 201.845.4461