Your Name:   

Title:   

Hospital/Facility:  
    
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 Code:   

Phone #:             Ext:   

 e-Mail:  

How do you prefer to be contacted: Email  Phone  Either

Facility Type:  Acute Care Hospital  Critical Access Hospital 

Long-term Acute Care Long-term Care  Skilled Nursing 

Other 

Total Beds:     Average Daily Census:    
 

Step Two: POSITION SPECIFICATIONS
 

Title of the individual position reports to:  

How long vacant: 

# of FTE's:  

RN Required (Registered Nurse) 

CPHQ Required (Certified Professional in Healthcare Quality) 

Degree:   Select One Degree Not Required Associates Preferred Associates Required Bachelors Preferred Bachelors Required Masters Preferred Masters Required     experience:   Select One 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years +

Salary:   Select One Paid Hourly Base Salary   Status:   Select One Exempt Non-Exempt  

Pay Range: (Low):    (Medium):    (High): 

Annual Bonus:   Select One Yes No  

If Yes, Annual Bonus Info/Percentage:

 

Relocation assistance provided:   Select One Yes No

If yes, how determined:   Select One Flate Rate Case By Case  

Sign-on Bonus:   Select One Yes No   Amount: 
            
Add general comments / special instructions / additional information here


Paste internal job description here (optional)

Your request will be handled promptly.  A confirmation email will be sent shortly and one of our Account Managers will contact you directly.

Thank you for your valuable time and we look forward to earning your business.
 
Step Three:   Send request to Galileo Search     Start over

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