Please complete the following form and a representative will contact you. Or if you prefer, call us at (206) 285.6300. We'll begin working on your assignment immediately. * This is a required field. * Facility Name * Contact * Address * City   * Email * State             Select AL AK AZ AR CA CO CT DE 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  Date(s) Needed to * Phone Reason For Need Select Low Census High Census Staff Vacation Staff Sick Leave Other Fax Shifts Needed     Select Morning Evening Night Any * Have you worked with AxisTM Medical Staffing before? No      Yes Specialty(ies) Needed: Medical ARRT Business Services Care Mgt/Risk Mgt/Utilization Review CCU/ICU (Critical/Intensive Care) Clinical Nurse Specialist CNA/NAC Assistant Emergency/Trauma/Triage Endoscopy Family Practice/Internal Medicine General/Float/Other Geriatrics IV Therapy LPN/LVN Medical Assistant Medical/Surgical Renal Dialysis/Nephrology Neurology Office-Support Staff Oncology/Hematology Orthopedic Pediatric Practitioner Surgical Services/OR QA/Infection control/ Epidemiology Radiology Recovery Telemetry Mother child (OB/GYN/L&D/Nursery/Neonatal) Psychology/Parish/Behavior Health/Addiction Technical/Programming       Dental Dental Hygienist Dental Assistant Brief practice description or other comments

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