Thank you for your interest in our services. Below is an information request form that will assist us in personalizing your search for the right practice. If you take the time to fill it out, we promise to promptly contact you in the method you request. All information is held in the strictest confidence and will not be shared with any other party without your personal consent. We are pleased to accept CVs via email at hcrjim@health-care-recruiting.com or fax: 541-317-9343. For those of you not yet acquainted with us, please know that we still enjoy using our telephone! Jim is always anxious to speak with you directly, creating a profile for you as you comfortably discuss your needs. 1-800-323-1732

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*E-mail address *Full Name *Street address *City *State *ZIP *Home Phone Work Phone Pager / Cell Phone Availability Date State Licenses Held Geographical Preference Specialty and Current Job Description Practice Preferences *How do you prefer to be contacted: Call at home Call discreetly at work Email

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