FCS-The first choice for psychiatric recruitment

PHYSICIAN PREFERENCE FORM
We welcome the opportunity to be of service to you. Please take a few minutes to fill out the following form so that we can assist you in finding the best psychiatric opportunity for you and your family. Feel free to call us at 800.783.9152, fax us at 270.782.1055, or Email us at admin@fcspsy.com.
Please fill in all fields marked with a *
email address*
Name*
Street Address*
City/State, Zip Code *
Residence/Office Phone*			Enter a time to call*
Preferred Cities or States	*
Date you would be available to begin working		Is employment of spouse or partner a factor?		Yes	No
Are you Board Certified?	Yes No	Are you Board Eligible? Yes No
States Licensed in
Preferred Facility*	Community Mental Health Center	Hospital		Solo Private Practice
	Academic	Single Specialty Group		Multi Specialty Group

Types of practice you find most interesting	General	Forensic		Child Adolescent
	Adult	Geriatrics		Dual Diagnosis
U. S. Citizen	Yes	No *
If no, Visa Status		Upload CV
Additional Info about you and your family that will help us assist you in your search		Copy and paste CV here, or upload (above)