Job Order | Staffing Request

Medical Facility

Facility Name

Address

City State Zip Phone

Facility Contacts

Contact Name Job Title

Contact phone # Fax # Email

Job Submission

Position Type: Contract PRN    Float Required: Yes No    If so, detail:

Shift Schedule    Hours: 8 12

Weekend Requirement

Holiday Requirement

Call Required:             Yes No    If so, detail:

Job Start Date

Job Description

Special Equipment & Additional Info:

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TESTIMONIALS

Bluegrass Healthcare were the most professional temporary staffing agency I've used in my 8 years as a travel nurse. I would recommend them to anyone!

- Rachel Brighton

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