About Us
AD Login
Agreement Request Form
Alleanza Direct Hire Summary
Authorized Partner Login
Blog
Contact Us
Create a password
Customer Login
Direct Hire Summary
Employee Login
For Employees
For Employers
Forgot Your Password?
Healthcare AD Resources
Healthcare Screen Request Form
Healthcare Submittal Form
Home
New Customer Summary
New Hire Summary
Pick a New Password
Privacy Policy
Quote Request Form
Results
Sample Page
Screen Request Form
Standard AD Resources
USA Staffing Services Healthcare Benefits
For Employees
For Employers
Contact
About USA Staffing Services
Resources
Join the Partner Program
Authorized Partner Login
Employee Portal Login
Time Approver Login
For Employees
For Employers
Contact Us
Healthcare Submittal Form
To submit Healthcare candidates to open orders, please complete and submit this form.
Completed By (Your name)
*
Your Company Name
*
Candidate Submission Information
Candidate Full Name
*
VMS or MSP Name
*
Job #
*
Personal Preferences and/or Restrictions (i.e. requested days off, etc)
*
If none please input N/A
Interview Availability Times
*
Skills Checklist Service
*
Do you need USA to provide a skills checklist to the candidate to complete?
Yes
No
Uploads
Please Upload ALL of the Required Attachments Listed Below
*
1) Resume and/or Application (Work History dating back at least 7 years)
2) 2 Recent References
- 2 References provided that are in the same specialty applying for
- References cover 1 year or more of experience
3) Copy of Certifications
4) Copy of License
5) License Verification
6) Driver’s License or Government Issued ID
7) Social Security Card / Number
8) Skills Checklist - (If you have issued your own skills checklist service, please attach. If USA is providing the service, we will provide)
(You may upload and/or drag and drop multiple files)
Drop files here or
Select files
Max. file size: 256 MB.