It's simple to advertise.

Print and fill out this form, then fax it to (318) 325-5089.
Or you may E-mail the information to accounts@medijob.com
MediJob Services, PO Box 5029, Monroe, LA  71211-5029  (318) 512-7053

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Date:______________________  Medijob Account No.:__________________________

Employer:_____________________________________________________________

Address:______________________________________________________________

City:______________________________  State:_______  Zip:___________________

Phone:_____________________ Ext:___________  Fax:________________________

Web address:__________________________________________________________

E-mail address:_________________________________________________________

Physician:______  Nursing:______  Allied Health:______  Add/Remove Position:_______

Position:______________________________  Dept.:___________________________

F/P Time, Perm/Temp:_____________________  Hours:_________________________

Description of position, duties, qualifications,and requirments: _____________________

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Salary and benefits:______________________________________________________

_____________________________________________________________________

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Additional information:____________________________________________________

_____________________________________________________________________

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Contact person and address (if different from above):____________________________

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Billing* contact person and address (if different from above):_______________________

_____________________________________________________________________

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By signing below I certify that I have read and agree with the terms of MediJob
and that I am authorized to open/make changes to the Medijob account.

Authorized signature:____________________________________________________
*See our rates page for billing information.