BlueSky Telepsych

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Personal Details

Full Name*

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Email Address*

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Phone Number*

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Address*

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Experience

Work History*

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Education*

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Experience Summary*

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Cover Letter

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  • What school did you attend for your PMHNP?*

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  • Have you graduated from your PMHNP program? If not, what is your expected completion date?*

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  • Do you have psychiatric experience as a nurse? If so, what setting, length of time, and employment status (ie. full time, part time, PRN, etc)*

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  • Do you have psychiatric experience as a nurse practitioner? If so, what setting, length of time, and employment status (ie. full time, part time, PRN, etc)*

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  • Do you currently operate a private practice or do you plan on doing so in the future?*

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  • Do you currently practice psychiatry at any outpatient psychiatric clinic? If so, in what states?*

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  • In which states do you have active or pending PMHNP licensure?*

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  • In which states do you have active or pending DEA licensure?*

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  • Are you open to additional state licensing?*

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  • Have you ever received any disciplinary actions by any licensure board? Are there any current investigations or legal proceedings related to your medical practice?*

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