healthcare employers - facility application

For information regarding our staffing services or to post an open position with MedStaff Healthcare Solutions, please provide the following information:

Contact Information
First Name *
Last Name *
Title
Organization Name
Address 1
Address 2
City
State	Alaska Alabama Arkansas Arizona Bermuda California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming SELECT STATE
Zip Code
Phone Number *	ext.
Fax Number
Email Address *
Needs
What are your current needs?	Fixed-Term Staffing (travel)
(Choose ALL that apply)	Flexible Staffing (per diem)
	Permanent Placement
	Management Consulting Services