Submit Applicant

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Recruiter Portal

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Recruiter Portal

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Recruiter Submission Portal

Submit a Qualified Applicant

Use this form to submit a screened and qualified applicant for review. Please include complete candidate details, job information, licensing, availability, compensation expectations, and recruiter notes.

Recruiter Information

Recruiter Full Name *

Recruiter Email Address *

Recruiter Phone Number *

Applicant Information

Applicant Full Legal Name *

Preferred Name

Applicant Email Address *

Applicant Phone Number *

Applicant Current City / State *

Applicant Profession *

Primary Specialty / Field *

Years of Relevant Experience *

Resume / CV Required: Please send the applicant’s resume or CV to resume@maverickwellnesspartners.com after submitting this form. Include the applicant’s name and Job ID in the email subject line.

LinkedIn Profile

Position Submitted For

Job ID Number *

Position Title *

Facility / Client Name

Position Location *

Placement Type *

Permanent Locum Tenens Contract PRN Temporary Not Sure

Select at least one.

Licensing, Credentials & Qualifications

Active State Licenses *

Board Certification / Eligibility *

NPI Number *

Required. Must be exactly 10 digits.

Certifications

Known Credentialing, Malpractice, Background, or License Issues? *

Credentialing Issue Details

Availability, Preferences & Compensation

Earliest Available Start Date *

Current Notice Period

Schedule Preference *

Compensation Expectation *

Relocation / Travel Willingness *

Interview Availability

Important Preferences or Deal Breakers

Candidate Qualification Summary

Why Is This Applicant Qualified for This Role? *

Candidate Interest Level *

Recruiter Screening Notes *

Additional Information

Submission Confirmation

The applicant has given permission to be submitted for this opportunity. * I have confirmed the applicant’s contact information is accurate. * I understand the applicant’s resume or CV must be emailed to resume@maverickwellnesspartners.com. * I have screened this applicant and believe they meet the basic qualifications for the role. * I certify that the information submitted is accurate to the best of my knowledge. *

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