* = Required Information
Profession
*
Administrator
Case Manager
Clinic Manager
Customer Service Representative
Dental Assistant
Dental Receptionist
EEG or EKG Technician
Executive
License Practical/Voc. Nurse
Medical Assistant
Medical Laboratory Technician
Medical Records Clerk
Medical Secretary
Medical Technologist
Occ. Therapist
Patient Account Representative
Phlebotomist
Physical Therapist
Qualified Rehabilitation Technician
Receptionist
Registered Nurse
Registered Nurse Clinician
Registrar
Surgery Scheduler
Surgery Technician
Switch Board Operator
OASIS- C Nurse
Psychiatric Nurse
Dietary Aide
Is this position temporary?
Yes
No
Is this position temporary to permanent?
Yes
No
Is this position permanent?
Yes
No
Firm
*
Firm Address
*
Person To Contact
*
Phone
*
Is this job order?
Solicited
Phone In
Mail
Face To Face
Other
Name of person ordering
*
Telephone Number with Area Code
*
E-mail Address
*
Experience
Special Training
Days
Hours
Job Description -Duties-Remarks
FEE STATUS
All Fees are in a contingency basis.
Security Code
*
Forms can be email or fax to
617-6077222
.