Galileo Search, LLC - Contractor Registry

Sign-up today and join our elite team of Infection Prevention, Quality, Patient Safety, Performance Improvement, Risk Management and Clinical Leadership Contracting Specialists.

You will be notified of contracting opportunities as they become available.  Working together, we can make a real difference!

      First: Last:

Address:

       City: 

     State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip:

   Phone:  Cell Phone:

Home Email Address:

Other Email Address:

Bilingual: Yes No   If yes, languages:

Are you new to Contracting: Yes No

Education, Licenses & Certifications

Are you a Registered Nurse (RN): No Yes

Are you a Medical Technologist  (MT): No Yes

Which certifications do you have (check appropriate box/boxes below):

CIC  ASCP  CPHQ  CPHRM  CNOR
 Other certifications:

Highest level of education: High School Diploma Associates Degree Bachelors Degree Masters Degree Doctorate Select

Healthcare Industry Experience

Acute Care  Long-term acute care Long-term care

Critical Access Hospital  Public Health  Clinical Laboratory

Research Laboratory

Geographical & Travel Information

Check this box if you are only available for local assignments with no overnight travel.

Select distance you will drive one way for a local assignment: 10 Miles 25 Miles 50 Miles 75 Miles 100 Miles

Check this box if you are available for assignments in any city or state.

If you are only available for assignments in specific states, check the box(s) in front of those states below: 

AL  AK AZ AR CA  CO CT  DE  DC 
FL  GA ID IL   IN    IA   KS  KY   LA 
ME MDM  MI   MN  MS MO MT  NE 
NV NHNJ NM NY  NC ND  OH OK
ORPA RI  SC  SD  TN TX   UT  VT 
VA WA WVWI  WY

List any preferred cities, travel restrictions or other geographical
information in the box below

Days / times during the week that you are available to work:

Monday (Anytime)
Monday (Standard daytime hours)
Monday (Evenings only) starting work at... Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm    

Tuesday (Anytime)
Tuesday (Standard daytime hours)
Tuesday (Evenings only) starting at...         Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm  

Wednesday (Anytime)
Wednesday (Standard daytime hours)
Wednesday (Evenings only) starting at...   Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm  

Thursday (Anytime)
Thursday (Standard daytime hours)
Thursday (Evenings only) starting at...       Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm  

Friday (Anytime)
Friday (Standard daytime hours)
Friday (Evenings only) starting at...             Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm

Saturday (Anytime)
Friday (Standard daytime hours)
Friday (Evenings only) starting at...             Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm          

Sunday (Anytime)
Sunday (Standard daytime hours)
Sunday (Evenings only) starting at...          Select 3:00pm 4:00pm 5:00pm 6:00pm 7:00pm

Resume

Please paste a copy of your resume into the box below for our
confidential review.

Once your information is complete, simply click the "Submit" button below.  Thank you for registering - we look forward to a long, and mutually beneficial professional relationship.