LET US KNOW YOUR STAFFING NEEDS!!!!
There is no obligation to you for
informing us of such intent....
it will only help us to anticipate your needs.

WE GUARANTEE OUR EMPLOYEES!
If for any reason, you are dissatisfied with an employee, and we are notified
of dissatisfaction within the first day, client will
not be charged for that placement.

Our internal office staff
have varying degrees of medical expertise,
which enables us to better assist
you with the right staffing for your medical facility.

Request Staffing/Positions
Please fill out information for assistance and information on our services
A red asterisk (*) indicates a required field.

Medical Facility:  *
Speciality:  *
Contact Information
Last Name:  *
First Name:  *
Middle Initial:
Title:
Site Address:
 		 *
City:  *
State:
 *  Zip:   *
Same As Above:
Billing Address:
City:
State:
  Zip: 
Phone 1:  *
Phone 2:
Fax:  *
E-mail:  *
Please Check one of the following methods to receive further information:
Fax:  Mail:  Email:  
Request for Staffing: (positions)
Number of positions needed:
Assignment Duration:
  Temp less than 2-3 months
  Temp less than 3-6 months
  Temp to Hire - 560 hours prehire
  Temp regular part-time
  On-going indefinite (not less than 1 month)
Rotation: (if applicable, explain)
Job Description: (if applicable)
Comments: (give information on procedures)