Request staff

Submit a staffing request

Maryland Health Care Staff Agency · HCSA-01637 — temporary healthcare staffing support across Maryland.

1Organization information

Facility / organization name*Facility typeContact person*Job titleBusiness email*Business phoneFacility addressCityStateZIP

2Staffing need

Position needed*Number of workers neededDate neededCoverage typeShift start timeShift end timeUrgency

3Assignment information

Unit / programRequired credentialsRequired trainingRequired competenciesOrientation requirementsDress codePPE requirementsDriving requiredFacility supervisorSupervisor phonePrimary dutiesAdditional instructions

Please do not include personal health information, diagnoses or identification numbers in this form.

4Recurring staffing (optional)This is a recurring staffing need

5Vendor / billing contact

Billing contactBilling emailBilling phonePurchase order requiredVendor onboarding required

Please do not submit bank account or payment card details through this form.

Submission of this form constitutes a staffing inquiry/request and does not guarantee coverage. Phillips Health Consulting LLC will review worker availability, applicable credentials, Client requirements, commercial terms and assignment details before confirming coverage.

I acknowledge and understand.

Questions? 667.367.4472