My Profile | ProTherapy Staffing

👤 Basic Information

First Name *

Last Name *

Email *

Cell Phone *

Discipline *

Years of Experience

Home Base (City, State)

License Number

📅 Availability & Assignment Preferences

Desired Start Date *

Contract Length

Min Pay ($/week)

Time Off Needed

Housing Preference

Target Locations (cities or states)

📍 States Licensed In

Select all states where you currently hold an active license (including Compact).

Notes on Licenses

🏥 Primary Setting & Specialty

Primary Practice Setting

Clinical Specialty

✅ Skills Checklist (select all that apply — this goes on your facility card)

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💬 Additional Information

EMR / Systems Experience

Certifications & Special Training

Anything else we should know?

How did you hear about ProTherapy?

🪪 Your Facility Card Preview

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Your Name

Discipline

ProTherapy
Staffing 🐻

License #—

Start Date—

Min Pay—

Time Off—

Setting—

Specialty—

Licensed In—

ProTherapy Staffing · protherapystaffing.com · @protherapystaffing

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