Trustaff - Travel Nurse Job Requests

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Complete the Job / Information Request form below and a trustaff sales or account manager will contact you within 24 hours to confirm your order and gather more information about your staffing needs. (*) Indicates a required field.

Contact Details
Contact Name *	Facility Name*
Title	Facility Address
Email *	City
Phone * - -	State*
Fax - -	Zip
Have you previously spoken with anyone at trustaff? Yes No
Do you have a current contract with trustaff? Yes No
How did you hear about Trustaff?
Staffing Needs
Job Description
Openings	Preferred Start Date //
Preferred Type / Length of Assignment Temporary/Travel Permanent Temp-to-Perm
If temporary / travel 4 weeks 8 weeks 13 weeks 26 weeks
Other Details	Questions/Comments

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