Submit Staffing Request

To ensure we meet your healthcare staffing needs as quickly and efficiently
as possible, please complete and submit this staffing request. 

A Staffing Specialist will contact you within 15 minutes of receiving your request.

Contact Information
*Facility name:
*First name:
*Last name:
Address:
City:
State:
Zip:
*Phone:
*E-mail address:
Fax:
Position Information
Have you worked with
Integrated Healthcare before?:
Yes No
Profession needed:
Per Diem      Travel Nursing      Allied Healthcare
Positions/Specialties needed:
Number of positions needed:
Shift:
8 hr      10 hr      12 hr
Shift time:
Days      Evenings      Nights
From date:
(mm/dd/yy)
To date:
(mm/dd/yy)
Reason for need:
 
Brief position description or
additional comments:


By submitting this form, you consent to Integrated Healthcare
contacting you using the contact information provided.




 
 
Copyright © 2009 Integrated Healthcare Staffing, LLC. All rights reserved.