Healthcare Administrators/Client Request Form

Please complete this form to submit your open positions or staffing requests to Careplus International, LLC. If you prefer to personally speak to our Specialists, please call 410-821-1941 or 410-790-4355. If you send this form via internet, our Client Specialist will contact you to confirm receipt of your request and to further discuss your staffing requirement.

Completing this form does not commit you in any way to accept the services we offer.

CONTACT INFORMATION

Hospital/ Facility:

Address:

Contact Person:

Email Address: 

Phone Number: 

Position/Title:

Best time to call you: 

ASSIGNMENT INFORMATION

Discipline:

Unit: 

Number of Staff Needed:

Length of Assignment:

Facility & Unit description/Typical Cases: