FASTAFF Staffing Request

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Hospital Healthcare Staffing Request- (for Hospital use only - If you are a nurse seeking a travel assignment please click here.)

Thank you for your interest in FASTAFF. Our goal is to help you with your healthcare staffing needs in a timely manner. Please fill out and submit this form and we will contact you within 24-hours (Monday - Friday).

Use the "Tab" key to move to the next field. Please do not press the "Enter" key.

(* indicates a required field)

Facility Information
*First Name:
*Middle Initial:
*Last Name:
Title:
* Facility Name
Address and Contact Information
* Mailing Address:
Suite
*City:
*State/Province:
* Zip/Postal code:

*Phone:	(e.g. 333-444-5555)
Fax number:	(e.g. 333-444-5555)
Email address:
How do you prefer to be contacted?	PhoneEmailPostal Address
Additional Information
* How did you find out about us?
If you were referred by a nurse or other source, please specify here:
Is your facility part of a healthcare network?	YesNo
If yes, which one?
*When do you anticipate needing help with your staffing requirements?
If other, please specify:
*Approximately how many travel nurses will you need?


Is your facility undergoing a special project (i.e. computer conversion, expansion, etc.)?	YesNo
If yes, when?
What Type?
If other, please specify:

What areas of expertise are you looking for, if any?


Please verify to make sure this information is correct before submitting. Thank you.