WY Nursing Connection Form
Thank you for your interest in serving the nursing needs of Wyoming's citizens. The Nursing Connect Form is designed to help employers seeking nurses, APRNs, and CNAs to find promising candidates for their positions. Please fill out the information below before submitting your form. You are permitted to change your answers by accessing this form at a later date.

Requests to be removed from this form may be sent to Phylicia Peterson, WSBN Business Coordinator, at phylicia.peterson1@wyo.gov.

****Terms and Conditions****
 This form is intended to provide a means of contact and connection between Wyoming nurses and potential employers. The WSBN does not take responsibility for any job posting, interview, or hiring request, or related communications or information received by use of this form.

All applicants who receive employment must notify Phylicia Peterson of their desire to be removed from the form if they desire not to receive further employment communications.

Questions or concerns may be emailed to Phylicia Peterson, WSBN Business Coordinator, at phylicia.peterson1@wyo.gov.
Email *
First Name *
Last Name *
Phone Number *
Email Address *
Preferred Method of Contact *
Type of Licensure/Certification *
Area of Specialty (EX: OB, Cardiac, ER, etc.)
Are you looking for Full or Part-Time work? *
Are you willing to travel for work? *
Do you have any questions or comments?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of State of Wyoming. Report Abuse
Google Forms