CPR: Provider Interview Form: Medical
By answering the questions below Colorado Provider Recruitment can gain a better understanding of what you are looking for in a community and a practice.
Sign up to work with CPR now!First Name*Last Name*Date Available*
City*State*What is your state of origin?E-mail Address*
Home or Cell Phone Number*Degree*CNMDDSDMDDOMDNPPARDHASNBSNSpecialty*Certified Nurse MidwifeDental HygienistDentistEmergency Medicine PhysicianFamily Nurse PractitionerFamily PhysicianGeneral SurgeonIM/PedsInternal Medicine PhysicianMedical DirectorOB/GYNPediatricianPhysician AssistantPsychiatristRegistered NurseMedical/Graduate/Training School*City/State*Month/Year Graduated*Residency Program (if applicable)Residency City/StateResidency - Month/Year GraduatedFellowship Program (if applicable)Fellowship - City/StateFellowship - Month/Year GraduatedBoard Status:Board CertifiedBoard EligibleWill be eligibleN/AIf going to be eligible, please indicate what date:
Licensed in what state(s):AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAre you interested in loan repayment?Current Position:*StudentResident or FellowIn practiceYears of Experience Post TrainingImportant Factors For Your Practice*Practice Preference: Inpatient, Outpatient, or BothI/PO/PBothDo You Require OB in Your Practice?YesNoNo PreferenceDo You Require C-sections in Your Practice?YesNoNo PreferenceDo You Have Prescriptive Authority?YesNoWill be eligiblePlease provide anticipated month/year you will have prescriptive authority:What are your salary requirements?Important factors in your selection of a location for you and your family*Preferred geographic area(s) in ColoradoPlease list all languages spoken:Residency Status*USH1-BJ1Permanent ResidentMarital Status*SingleMarriedSignificant OtherWill your spouse/significant other be seeking employment?Spouse/Significant Other's OccupationNumber of childrenHow did you hear about CPR?3RNetColorado Health Service Corps Loan Repayment WebsiteJob FairOnline Job BoardProfessional ConferenceResidency/School PresentationWeb SearchWord of Mouth - Colleague/FriendWord of Mouth - Professional OrganizationName of job fair, job board, conference, or word of mouth referral:Resume Upload