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Request Staffing Form
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Request Staffing Form
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Name
*
First
Last
Staffing Manager or Qualified Staff
Email
*
Contact email
Company
*
Agency requesting staffing service | Name & Address
State
*
Minnesota
Colorado
Other
Select location where services will be delivered
Phone
*
Contact Phone Number ( 1xxxxxxxxxx) No dashes, required format
Which position do you want to staff?
*
Licensed Practical Nurses
Certified Nursing Assistants
Registered Nurses
Trained Medical Aides
Nurse Aides
Orderlies
Other
1 Medical Staffing Solutions, Inc. is licensed to staff and provide the above listed services, If service seeking is not listed, please contact our staffing team for additional assistance in meeting your needs.
When do you need staff?
*
Enter estimated date to place staff.
Special Instructions/Comments
Provide additional important instructions related to your request.
Name
Submit
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