Mercury Group Staffing

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Facility Name

Facility Type

Contact Person Name

Email Address

Facility Address

Preferred Contact Method

Position(s) Needed

Number of Staff required

Type of Employment

Shiff Details

Start Date

End Date

Expected Hours Per Week

Specific Skills or Certifications required

Patient or Client Population

Special Requirement

EMR/Software Knowledge

Budget Range or Pay Rate

Preferred Payment Term

Billing Contact

Urgency of Request

Reason for Staffing Need