Brown Medical Staffing – Request Staff

Brown Medical Staffing – Request Staff

Share your facility details, staffing roles and headcount, schedule needs, and urgency—then review the acknowledgment before submitting.
Facility Information
Facility / Organization Name
Facility Type
Facility Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP Code
Website
Primary Contact
Full Name

First NameMiddle NameLast Name
Job Title
Work Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Contact Method

Other
Best Time to Contact

Hour Minutes

AM/PM Option
Staffing Request
Professionals Needed

Other
Specify Other Role
Number Needed / Headcount
Staffing Type
Department / Unit / Specialty
Required Experience or Skills
Required Certifications

Other
Facility-Specific Credential Requirements
Schedule & Assignment Details
Requested Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date or Estimated Duration
Shift

Custom
Shift Start Time

Hour Minutes

AM/PM Option
Shift End Time

Hour Minutes

AM/PM Option
Days of Week Needed
Hours per Shift
Estimated Shifts per Week
Overtime Expected?
Orientation Required?
Orientation Length
Location & Travel
Primary Worksite Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Will multiple locations be involved?
Parking / Travel Notes
Is mileage, lodging, or travel reimbursement available?
Urgency
When is coverage needed?
Briefly describe the staffing challenge or reason for this request
Rates & Contracting
Approved bill rate or budget range already set?
Bill rate by role
Required onboarding, procurement, credentialing, insurance, or contract steps

Other
Existing staffing agreement or vendor packet available?
Upload RFP, rate sheet, vendor packet, or staffing requirements

Cancelof
Billing & Administrative Contact
Is the billing contact the same as the primary contact?
Billing contact name

First NameLast Name
Billing contact title
Billing contact email
example@example.com
Billing contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Typical invoice/payment terms
Do timesheets require supervisor approval?
Approving supervisor name

First NameLast Name
Approving supervisor title
Final Details
Additional Comments or Special Instructions
Preferred Date and Time for Contact

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Should be Empty:

Brown Medical Staffing – Request Staff

Facility Information

Primary Contact

Staffing Request

Schedule & Assignment Details

Location & Travel

Urgency

Rates & Contracting

Billing & Administrative Contact

Final Details