NEXIM HEALTHCARE CONSULTANTS INC.

Prospect Screening Questions

 






YesNo

YesNo
YesNo
YesNo


YesNo

YesNo

Are you willing to travel to the following locations?

YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo

What is your availability

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Day shift
Afternoon shift
Overnight shift
YesNo

YesNo


YesNo

YesNo

Please provide three employment related references, including your current supervisor.

In addition to the references provided by the applicant, the Company reserves the right to
contact others who it deems relevant and appropriate in the assessment of this application.

Name and Title Employment Relationship Company and Phone Number

Name and Title Employment Relationship Company and Phone Number

Name and Title Employment Relationship Company and Phone Number