Name* First Last Date* MM slash DD slash YYYY Why are you interested in working at NCAP and are you familiar with Northern Colorado/ Wyoming? What would you bring to NCAP’s great CRNA team?*Describe the types of care models you have worked in during your career/training (e.g, medically directed, medically supervised, solo). What is your preferred care model and your preferred level of independence/supervision in practicing? (NCAP uses a medically-supervised care team model.)*NCAP provides anesthesia services in three geographic areas. Which do you prefer?* NORTH pod: Fort Collins, Loveland, Greeley SOUTH pod: Lafayette WYOMING pod: Laramie There are several CRNA scheduling models, not all of which may be available at any given time. Please indicate all types you may have interest in.* North: W-2 Employee: With overnight and pager responsibilities North: W-2 Employee: Full-time Day Work North: W-2 Employee: .8 FTE Day Work South: W-2 Employee: Full-time with pager responsibilities South: W-2 Employee: .75 FTE, with pager responsibilities North and South: 1099 Contractor, various shifts Wyoming: W-2 Employee: Full-time If interested in a 1099 Contractor (PRN), position please let us know your availability for day, evening, overnight, and pager shifts.*Please tell us about the practice characteristics that are the most important for your next career move (e.g. types of cases you prefer, your ideal work environment/culture, preferred hours of work/call per week, etc.).*What are your annual compensation expectations for this position?*What is the earliest date (month/year) you would be available to start working at NCAP? Also, please describe any advance notice requirement you have with your current practice.*How did you discover NCAP?* Referred by a current employee. Gaswork.com NCAP website Met NCAP at a recruiting event Other Other Current Employee Referral Which recruiting event did you hear about NCAP at? Has your license ever been suspended, revoked, or denied? Have clinical privileges ever been denied to you, limited, revoked, etc.? Have you even been subject to disciplinary action by a state medical board or any facility at which you were credentialed?* Yes No Please Attach Resume*Max. file size: 300 MB.Additional Documents (references, case logs, etc) Drop files here or Select files Max. file size: 300 MB, Max. files: 10.