This information will be shared with potential candidates for your position.

* 1. Please provide contact information (person who should receive candidate referral information) and the address for organization's main site:

* 2. If name/address of site where the clinician will practice is different from the main site information above, please provide the actual practice site details:

* 3. Start date -- when will the clinician need to begin work?

Date 
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* 4. What clinical discipline do you need [family practice physician, internal medicine physician, physician assistant, family nurse practitioner, etc.]? If the position may be filled by more than one discipline (either a family practice or an internal medicine physician, or a family physician or nurse practitioner or physician assistant), please indicate that.

* 5. How many clinicians and what disciplines are at this practice location (# of physicians, # nurse practitioners, # physician assistants)?

* 6. Will you accept a J1 Visa candidate?

* 7. Indicate all answers that describe the site where the clinician will work:

* 8. Is the practice site in a health professional shortage area (HPSA), and if so what is the HPSA score and  type of designation?

* 9. What are the best 3 things about being a practicing clinician at your practice site?

* 10. Can the candidate expect a 40-hour week, and if not, what type of schedule will be expected?

* 11. If your practice has multiple sites, will the person you hire only practice at one site or rotate among two or more sites? Please explain expectation.

* 12. If hospital coverage is required, please say more about what is expected. How is back-up call provided when the provider is away?

* 13. What is the salary range for this position?

* 14. What benefits are offered? CHECK ALL THAT APPLY.

* 15. What things about the area/community would be the outstanding attractions [outdoors activities like hiking, biking, cultural opportunities, historical sites, etc.]?

* 16. Please send any marketing material and/or a photo of our site and/or community to dprimm@tha.com. Provide any additional job details that would attract a potential candidate to your job and the community.

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