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First Name

Last Name

Email Address

Phone Number

Specialty SpecialtyNon-InvasiveInvasiveInterventionalElectrophysiologyCardiovascular Surgery

Work Interest Work Interest Permanent Placement Short Term Locums Long Term Locums Service Line Management

Years of Experience Years of Experience 0 Years 1-3 Years 5-10 Years 10+ Years 20+ Years

Preferred Salary (Annual) Preferred Salary (Annual) $0-150K $150 - 300K $300 - 500K $500 - 850K

# of Procedures (willing to do per month) # of Procedures (willing to do per month)NoneLight (1-5/mo)Active (5-15/mo)Heavy (15+/mo)

Board Certifications Board Certifications Board Eligible Board Certified Not eligible/certified

Additional Board/Specialty Certifications (Eg. ABIM Interventional Cardiology)

Imigration Status Imigration Status J1 Visa H1B US Citizen

State Licenses (Eg. CA, TX, NY...)

Preferred Work Region Preferred Work Region West Southwest Midwest East Southeast

Preferred Area Preferred Area Large Urban Urban Suburban Rural

Preferred Work Environment Preferred Work Environment Large Hospital (200+ beds) Small Hospital Academic Private Practice Large Group Mixed Practice Non-profit Charity Clinic