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PRN Questionnaire
PRN Questionnaire
PRN Questionnaire
PRN Name
*
First
Last
Discipline
*
Please select
PT
PTA
OT
COTA
SLP
CFY
Aide
Are you interested in continuing to work Per Diem for Tender Touch?
*
Yes
No, please remove me from your database
Please list all counties that you are available to help cover
*
Are you dual licensed?
*
Yes
No
Which states are you licensed in?
*
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