Provider Recruitment Inquiry Provider Recruitment InquiryProvider Recruitment InquiryFirst NameLast NameAddressCityStateZip CodeEmailPhonePreviousNextMy desire to make contact is based on one of the following: I am a licensed dentist and am seeking employment placement in the field of dentistry. I am a licensed dental hygienist and am seeking employment placement in my field. I intend to enter a dentistry program following undergraduate school and will be seeking acceptance at a school of dentistry. I intend to enter a dental hygienist program and will be seeking acceptance at a dental hygiene school. I am a licensed medical provider (physician, nurse practitioner or physician assistant) and am seeking employment placement in my field. I intend to enter a medical provider program (physician, nurse practitioner or physician assistant) following undergraduate school and will be seeking acceptance at an appropriate school. I am a licensed Registered Nurse or am about to be licensed as a Registered Nurse and am seeking employment placement in the field of Nursing. I am in the field of healthcare, other than in one of the fields mentioned above, and am seeking employment placement. I am in high school or college and would like to work in one of the healthcare fields not mentioned above. I am looking for a college to attend in Louisiana. PreviousNextI have been a dentist for:- Select One -Less than one yearOne to five yearsMore than five yearsI currently practice in a (type of geographical area):- Select One -Rural area (Population less than 25,000)Non-rural area (Population more than 25,000)I currently practice in the state of:- Select One -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI have been a practicing dental hygienist for:- Select One -Less than one yearOne to five yearsMore than five yearsI currently practice in a (type of geographical area):- Select One -Rural area (Population less than 25,000)Non-rural area (Population more than 25,000)I currently practice in the state of:- Select One -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI am currently:- Select One -In high schoolAn undergraduate FreshmanAn undergraduate JuniorAn undergraduate SophomoreAn Undergraduate SeniorPursuing a graduate degreeOtherYou selected "Other", enter your response below:I am currently:- Select One -A freshman in high schoolA sophomore in high schoolA Junior in High SchoolA Senior in High SchoolPursuing an undergraduate degree at an accredited college or universityOtherYou selected "Other", enter your response below:I am licensed as a (an):- Select One -M.D. or D.O.A.P.R.N.Physician AssistantI currently practice in the state of:- Select One -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI have been a licensed medical provider for:- Select One -Less than one yearOne to five yearsMore than five yearsI currently practice in a (type of geographical area):- Select One -Rural area (Population less than 25,000)Non-rural area (Population more than 25,000)My area of specialty is:I am currently:- Select One -In high schoolAn undergraduate FreshmanAn undergraduate JuniorAn undergraduate SophomoreAn Undergraduate SeniorPursuing a graduate degreeOtherYou selected "Other", enter your response below:I have been a Nurse for:- Select One -Less than one yearOne to five yearsMore than five yearsI currently practice in a (type of geographical area):- Select One -Rural area (Population less than 25,000)Non-rural area (Population more than 25,000)I currently practice in the state of:- Select One -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI am a Licensed or Certified:I currently work or practice in the state of:- Select One -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificI have been a licensed or certified in my area for:- Select One -Less than one yearOne to five yearsMore than five yearsI currently practice in a (type of geographical area):- Select One -Rural area (Population less than 25,000)Non-rural area (Population more than 25,000)I want to go into the field of:PreviousSubmit Form
