Local Providers
I am a
Primary specialty
Please tell us in which of these environments you are willing to work.  Check all that apply.
How did you hear about us? (Required Field)
How did you hear about us? (Required Field)
Full Name
Cell or Res Phone
Email
Salary Requested
State(s) Licensed
Home City & State
Availability
I will become available on or about this date
Additional data on availability. 
Currently, or when I become available, these are the days I would like to work:
By submitting this form you consent to The AJ Riggins Search Group and its affiliates contacting you at the phone numbers and/or email addresses provided.
Group Practice
Hospital
Medicaid
Community Health
Correctional Care
Native American Outreach Center
I don't mind Kids
I don't mind Kids under 5
I am currently available for locum work and could start immediately
I am currently not available for locum work, but WILL BECOME AVAILABLE as indicated below
Mon
Tue
Wed
Thu
Fri
Sat