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).

We have highly qualified nurses ready to go today! Sign up for our candidate search agent to receive weekly updates on nurses who meet your specialty, credential and experience requirements and want to travel to your facility NOW! Sign up today!

(The red asterisk * 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.