Step 1 of 3 33% Employer ApplicationDate MM slash DD slash YYYY Job Search Order Number As the employer, you know exactly what type of professional you are seeking. Fill out the information below for us to understand your needs and find the perfect candidate for you. After completing the form, send it to us. Our understanding of your needs will establish this protocol for conducting an effective search for you. While your criteria will likely be refined and modified as we get to know your needs better, it is helpful to begin with a basic vignette of the type of candidate you prefer. We look forward to assisting you in your continued success. Name* First Last Title: Email* Office Phone:*Fax:Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tell us about the position you want filled:*Position, Exact Title:* Facility/Office:* Start Date:* MM slash DD slash YYYY Direct Supervisor:* Supervisor's Title:* Salary Range:*Low Salary* Preferred Salary* Top Salary* Bonus:* Yes No Explain:*Commission:* Yes No Explain:*Other Compensation Package:* Yes NO Explain Other Compensation Package:*Vacations:* Yes No Explain Vacations:*Medical or Dental Insurance Available:* Yes No A Car Necessary* Yes No Is Car Furnished* Yes No Describe The Background And Education Required For This Position:*Education, Certification, and Licensure Preferences ( Check one or more below ):* KS AA BA OT PT Check one or more:* PA BS BBA BA BSN Check one or more:* RN MSN MA MS LCSW Check one or more:* MSW MBA MHA PhD DO Check one or more:* MD ACHE LPN RDH DDS Other Educational/Licensure Preference:* Yes No Explain*Other Requirements:* Yes No Explain*What experiences (Positions, Setting, and Title) are absolute minimum prerequisites for the successful candidate?* Yes No Explain*Special Skills/Knowledge Preferred:* Yes No Explain*How many years of experience do you prefer?*Please Select OneLess than a Year1-2 Years3-6 years7-9 years10 + YearsPlease Explain*Completed By* Fees: Client understands that Alppha's Nurse Staffing incurs recruiting expenses on a risk-based contingency basis and will be compensated through payment of a recruitment fee upon successful hire of a referred candidate.NameThis field is for validation purposes and should be left unchanged.
