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| Anesthesiologist's Name (Preferred name in parentheses) |
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| Contact Name |
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| Contact Street Address 1 |
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| Contact City |
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| Contact State |
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| Contact Zip Code |
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| Contact Country |
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| Contact Voice Phone |
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| Contact Fax |
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| Preferred Contact Method |
| Brief Description of Candidate |
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| States where clinician wants to work |
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| Check any Position Durations you would consider: |
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| Date Available |
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| If Locum Tenens, to what end date can Anesthesiologist work? |
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If Locum Tenens, what is the anesthesiologist's minimum daily charge? |
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| Does Anesthesiologist want a Director of Department position? |
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| Does Anesthesiologist want a job that leads to partnership? |
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| How often the Anesthesiologist wants to do the following: |
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| Does Anesthesiologist have ABA Certification in Pain Management? |
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| Does Anesthesiologist have ABA Certification in Critical Care Management? |
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| How often Does the Anesthesiologist want to be on call? |
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| Does the Anesthesiologist want to have the Day off after call? |
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| Does the Anesthesiologist want to be personally providing anesthesia care, i.e. One anesthesiologist to One patient? |
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| Does the Anesthesiologist want to be Medically Directing CRNAs or Anesthesiologist's Assistants (AAs)? |
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| What percentage of the time does the Anesthesiologist want to be personally providing anesthesia care, (doing own cases) compared to Medically Directing a CRNA or AA? |
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| What would be the Anesthesiologist's preference regarding CRNAs in a job situation doing Operative Cases that are not medically directed by an anesthesiologist? |
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| What would be the Anesthesiologist's preference regarding CRNAs in a job situation doing Labor Epidurals that are not Medically directed by an anesthesiologist? |
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| Does the Anesthesiologist want a job where there is an Approved Physician Anesthesia residency program? |
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| Does the Anesthesiologist want a job where there is Anesthesia training for Physician house staff? |
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| Does the Anesthesiologist want a job where there is a CRNA training program? |
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| Does the Anesthesiologist want a job where there is an Anesthesiologist's Assistant training program? |
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| What practice setting does the Anesthesiologist have Experience? |
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| What size hospital does the Anesthesiologist want to work in? (How many Licensed beds does the hospital have) |
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| City Population desired |
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| Is Anesthesiologist a foreign national needing a sponsor for Nonimmigrant Visa (H1B; J1; 01)? |
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| Estimated Minimum Annual Income Desired (W-2 Salary or 1099 Payment) |
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| Employment Status Desired: Employee (IRS form W-2) or Independent Contractor (IRS form 1099). |
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| Does the Anesthesiologist want a Salary income from anesthesia group? |
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| Does the Anesthesiologist want a Percentage income from anesthesia group? |
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| Does the Anesthesiologist want an Income from Fee-for-service individual practice? |
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| Does the Anesthesiologist want a Salary from Hospital as an employee? |
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| Does the Anesthesiologist want Other income as a Hospital employee? |
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| States where Anesthesiologist is licensed |
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| Anesthesiologist's Degree |
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| Anesthesiologist's Medical School |
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| Anesthesiologist's Residency |
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| Is Anesthesiologist Board Certified by the American Board of Anesthesiology (ABA)? |
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| Year of Primary Certification |
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| Has Anesthesiologist obtained ABA Recertification? |
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| List year(s) of ABA Recertification |
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| Comments about Anesthesiologist's Board Certification |
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| Has Anesthesiologist completed a Subspecialty Fellowship? |
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| Does Anesthesiologist have Subspecialty Expertise but has not completed a Fellowship? |
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| If Anesthesiologist has subspecialty expertise or has completed a Fellowship, which one? |
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| Is Anesthesiologist a New Graduate? |
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| Current Employer Name |
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| Current Employer Address/City/State/Zip |
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| Anesthesiologist's reason for seeking a job change? |
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| Name of a reference person |
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| Reference's phone |
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| Date Posted | 07/29/10 11:55am |
| Last Updated | 08/29/10 11:04am |
| Posted By | desverreauxmg@aol.com |
| Reference # | 120040 |
| Priority | General Posting |
| Section | Anesthesiologist |
| Form Type | CV |
| User Type | Individual: Anesthesiologist |
