Medical Temporary Search Assignment

Submitting this assignment is FREE.  Fee Information

Warning:  If you need this temporary in 24 to 48 hours, you must call 770-998-7770 ext 129 to place the order.  We cannot guarantee response in 24 hours.

Company Information

Company  

Contact Name

Contact Title

Address

Address

City   

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip

Main Phone

Fax 

E-mail address

Have you used our service before?  Yes No Not Sure -Choose-

Type of Company   Physicians Office Offsite Billing Hospital Urgent Care Home Health Lab Other

Order Information

Position Title 

Standard Temporary             Temp to Hire 

Duties 

Pay Range 

Start Date  January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2005 2006 2007 2008 2009

End Date  January February March April May June July August September October November December    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1999 2000 2001 2002

Hours  8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 AM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM 12:00 PM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM      to    5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM 12:00 PM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 AM 1:00 PM 2:00 PM 3:00 PM 4:00 PM         

Days    M     T    W      Th      F   S

Dress Code  Business/Conservative Business/Casual Scrubs -Choose-

Special Billing Instructions (would you like your bill sent to another address?)

Any Other Special Instructions?