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FCS Job Opportunity Form

Please print out this form, complete it, and fax it to FCS at 270.782.1055.

One of our recruiting professionals will respond to you promptly.

                                    JOB OPPORTUNITY
                Add________		Change ________	     Delete_________

Client name: _______________________________________________________________________________ 
City / State ________________________________________________________ Pop___________________
Contact name: ____________________________________________ Position: _______________________

What type of facility are you?  
CMHC________ Hospital________ PP________ Multi spec ________ Academic ________ FP___________    
NFP____   (CMHC and Hosp)

Are you an under served area? _____ Will you support a J1  ____  H1____
Other ______________________________________________________________________________________

What do you need? 
GA _____ CA ______ Geriatric ______	C&L ______	 Forensic ______ ECT ______ 
Addiction_____   Psycho Pharmacology____   Public Psychiatry___  Sleep disorders_____ 
Woman’s disorders______  Eating disorders___

Do they need to be BC ________ or BE________ Will you consider resident_____________________
New position ________ Replacement ________
How urgent is the need to fill this position?_______________________________________________
How are you covering the position now? _____________________________________________________
Are you currently looking at anyone right now?______________________________________________

Information about position 
Is this a staff position________ medical directorship ________ 
Private practice________ Hrs/ week____    Call : during the Week ________ 
Week end________ Phone call________
Salary ___________________________________ Incentives_______________________________________ 
Net Income Guarantee____________  For NIG is there forgiveness______________________________
____________________________________________________________________________________________
#Psychiatrists in unit_____  
What percent  In patient ______ % Out Patient ______ % IP 100%  What is length of stay______ 
Total # beds in facility________ #Psych  beds ________ 
Are the beds adult, geriatric or child_____________________________
How long for med checks________ How long for eval________
GA What ages 12&up________ 18&up________
CA What ages________ What % of child (3-12) ________  What % Adoles (12-18) ________

Benefits:
Vacation ____________	CME ____________		Holidays ____________
Sick days____________	Disability _________		Retire_______________
Malpract____________		Life Ins____________		Hlth/ Dent____________
Reloc exp____________	Temp cost of living ________	Sign on Bonus_______
Is there any help with student loans for new residents? ____________________________________
Brief Job Description: _____________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Nearby cities_______________________________________________________________________________
Recreational activities: ___________________________________________________________________
Cultural activities: _______________________________________________________________________
Attractions: _______________________________________________________________________________