Quality Medical Staffing AGency of Acadiana


This Job Order Form is not a final agreement. Please fill out in details.

Job Title
Is This Position Temporary ?				Yes		No
Is this position temp. to permanent ?				Yes		No
Is this position permanent ?				Yes		No

Firm
Firm Address
Person To Contact				Phone
Is This Job Order
Solicited	Phone In		Mail		Face To Face		Other
Name Of Person Ordering
Telephone Number with Area Code
E-mail Address
Experience
Special Training
Minimum Salary
Maximum Salary
Commission
Bonus
Days
Hours
Vacations
Is Medical/Dental Benefits Available ?				Yes		No
Is Profit Sharing Available ?				Yes		No
Car Furnished?				Yes		No
Car Necessary				Yes		No
Territory
Job Description -Duties-Remarks
FEE STATUS		All Fees are in a contingency basis.