Healthcare Submittal Form Healthcare Submittal Form To submit Healthcare candidates to open orders, please complete and submit this form. Completed By (Your name)*Your Company Name*Candidate Submission InformationCandidate Full Name*VMS or MSP Name*Job #*Personal Preferences and/or Restrictions (i.e. requested days off, etc)*If none please input N/AInterview Availability Times*Skills Checklist Service*Do you need USA to provide a skills checklist to the candidate to complete? Yes No UploadsPlease Upload ALL of the Required Attachments Listed Below 1) Resume and/or Application (Work History dating back at least 7 years) 2) 2 Recent References - 2 References provided that are in the same specialty applying for - References cover 1 year or more of experience 3) Copy of Certifications 4) Copy of License 5) License Verification 6) Driver’s License or Government Issued ID 7) Social Security Card / Number 8) Skills Checklist - (If you have issued your own skills checklist service, please attach. If USA is providing the service, we will provide) (You may upload and/or drag and drop multiple files) Drop files here or This iframe contains the logic required to handle Ajax powered Gravity Forms.