"*" indicates required fields Let’s chat! Zuricare connects great facilities with amazing caregivers. Please complete this form and we’ll be in touch soon.First Name*Last Name*Email* Street Address*City*State*Choose Your StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code*I am a:* Caregiver Facility representative Government agency representative How can we help you?* I’d like to join Zuricare’s caregiver team I’d like to find a current opening Other Other (please specify below)I am a/an:*Certified nurse assistant (CNA)Licensed practical/vocational nurse (LPN)Registered nurse (RN)PharmacistPhysicianOtherTo join our team or find a current opening, please tap the “Job Seekers” button on our home page and follow the prompts.What do you do?How can we help you?* We’d like to sign a contract with Zuricare We’d like to hire a Zuricare caregiver Other Other (please specify below)We are interested in (please select one or more)* Per diem caregivers Long-term & permanent caregivers Traveling caregivers Locum tenens caregivers International caregivers Other Other (please specify below)*We are interested in (please select one or more)* Certified nurse assistants (CNAs) Licensed practical/vocational nurses (LPNs) Registered nurses (RNs) Pharmacists Physicians Other Other (please specify below)*We are interested in hiring (please select one or more)* Certified nurse assistants (CNAs) Licensed practical/vocational nurses (LPNs) Registered nurses (RNs) Pharmacists Physicians Other Information about your CNA needsType of hire Per diem Long-term Permanent Traveling Locum tenens International Emergency & Crisis Per DiemNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver Start Time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLong-termNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver Start Time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agencys zip codePermanentNumber of caregiversPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeTravelingNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLocum tenensNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInternationalNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeEmergency & CrisisNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInformation about your LPN needsType of LPN hire Per diem Long-term Permanent Traveling Locum tenens International Emergency & Crisis Per DiemNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLong-termNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codePermanentNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeTravelingNumber of caregiversPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLocum tenensNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInternationalNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeEmergency & CrisisNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInformation about your RN needsType of RN hire Per diem Long-term Permanent Traveling Locum tenens International Emergency & Crisis Per DiemNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLong-termNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codePermanentNumber of caregiversPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeTravelingNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLocum tenensNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInternationalNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeEmergency & CrisisNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInformation about your pharmacist needsType of pharmacist hire Per diem Long-term Permanent Traveling Locum tenens International Emergency & Crisis Per DiemNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLong-termNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codePermanentNumber of caregiversPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeTravelingNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLocum tenensNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInternationalNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeEmergency & CrisisNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInformation about your physician needsType of physician hire Per diem Long-term Permanent Traveling Locum tenens International Emergency & Crisis Per DiemNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 100.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLong-termNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codePermanentNumber of caregiversPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeTravelingNumber of caregiversPlease enter a number from 1 to 999.Approximate no. of hours per caregiverPlease enter a number from 1 to 999.Caregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeLocum tenensNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeInternationalNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s zip codeMy agency’s nameEmergency & CrisisNumber of caregiversPlease enter a number from 1 to 999.Approximate length of hireCaregiver start date MM slash DD slash YYYY Caregiver start time Hours : Minutes AM PM AM/PM My facility’s nameMy facility’s zip codeMy agency’s nameMy agency’s zip codeOther (please specify below)NameThis field is for validation purposes and should be left unchanged.
