HealthPro Staffing Resources personally interviews each of our candidates to ensure the best fit for your practice. Please complete the form below or call 914-245-3200 to discuss your temporary or permanent needs. We look forward to working with you!

Employer Information

* Indicates required information

* Client/Group Name:

* Employer Name and Contact Person:

Specialty:

Billing Address:

Suite:

City:

State:

Zip Code:

Worksite/Corporate Address:

Suite:

City:

State:

Zip Code:

Office Phone:

Fax Phone:

Home Phone:

Alternate Phone:

Cell Phone:

* Email Address:

* Position Needed:

Salary Range:

* This position is:

Permanent

Temporary

Please list Dental Skills if required:

Please list Medical Skills if required:

If Managerial/Administrative/Front Desk Skills are required, please complete the following:

Computers

List Software:

Additional Skills:

For a Permanent position, please complete the following


Benefit Package:	Yes No	Additional Benefits:
Medical Plan:

Pension Plan:		Sick Days:
Vacation Time:		Personal Days:

Experienced Required:

Yes

How many years?:

Days and Hours required:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours:

Start Date for Position:

Does your office comply with OSHA Regulations?:

Please describe office setting, staff size, and any additional comments:

For a Temporary position, please complete the following

Experienced Required:

Yes

How many years?:

Start Date for Assignment:

Ending Date:

Days and Hours required:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Dates:

Hours:

Does your office comply with OSHA Regulations?:

Please describe office setting, staff size, and any additional comments:

If group practice, who would temp be working with?

Will temp be paid:

End of Day?:

On Payroll Cycle?: What day is Payday?

Reason for temporary assignment?

Possibility of temporary position becoming permanent? Yes No

Please include directions and parking instructions:


		Home \| Find the RIGHT Professional \| Find the RIGHT Job \| Newsletter \| Contact Us Phone (914) 245-3200 \| Fax (914) 245-3888 \| Email info@healthprosearch.com © Copyright 2003-2006 HealthPro Staffing Resources. All rights Reserved, USA and Worldwide.