MEDNEX Healthcare & Pharmaceutical Recruiters

Your Name:
Position to be Filled:
Your Company:
Address 1:
Address 2:
City	State	Zip Code
Hiring Manager Name & Title
Does this position report to you? Yes No
If not, who does this person report to?
Your Phone:
Fax:
E-Mail:
Full Time Part Time
Hours:
Job Description:
Job Requirements:
What educational requirements and/or training certificates are required?
Comments about Office Environment
If Direct, what is the Company Package?
Salary Range:
Bonus Potential:
What amount of travel is involved with this position?
Is relocation an option?
If we find someone who is perfect but will exceed the bill rate, do you want to consider him/her? Yes No
What is the anticipated start date?
Upward or Lateral Mobility?
Benefits (check all that apply): Health plan Dental and/or Vision Vacation 401K Bonus/Incentives Options/other
What interviewing times are convenient for you?
Have you presented this position to other recruiting companies? Yes No
Do you have any other needs?