Vendor Application
Client Registration
Client Order
Yankee Alliance
Who We Are
Our Team
How Can We Help You
Client Order
Health System Name
*
Facility Name
*
Facility Address
*
Contract of Per Diem Request
*
Contract
Per Diem
Job Class
*
Area
*
Quantity
*
Assignment Start Date
*
Assignment Length
*
Days
Weeks
Assignm
*
1
2
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10
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Shift Start
*
12:00 AM
12:15 AM
12:30 AM
12:45 AM
1:00 AM
1:15 AM
1:30 AM
1:45 AM
2:00 AM
2:15 AM
2:30 AM
2:45 AM
3:00 AM
3:15 AM
3:30 AM
3:45 AM
4:00 AM
4:15 AM
4:30 AM
4:45 AM
5:00 AM
5:15 AM
5:30 AM
5:45 AM
6:00 AM
6:15 AM
6:30 AM
6:45 AM
7:00 AM
7:15 AM
7:30 AM
7:45 AM
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
4:45 PM
5:00 PM
5:15 PM
5:30 PM
5:45 PM
6:00 PM
6:15 PM
6:30 PM
6:45 PM
7:00 PM
7:15 PM
7:30 PM
7:45 PM
8:00 PM
8:15 PM
8:30 PM
8:45 PM
9:00 PM
9:15 PM
9:30 PM
9:45 PM
10:00 PM
10:15 PM
10:30 PM
10:45 PM
11:00 PM
11:15 PM
11:30 PM
11:45 PM
Shift End
*
12:00 AM
12:15 AM
12:30 AM
12:45 AM
1:00 AM
1:15 AM
1:30 AM
1:45 AM
2:00 AM
2:15 AM
2:30 AM
2:45 AM
3:00 AM
3:15 AM
3:30 AM
3:45 AM
4:00 AM
4:15 AM
4:30 AM
4:45 AM
5:00 AM
5:15 AM
5:30 AM
5:45 AM
6:00 AM
6:15 AM
6:30 AM
6:45 AM
7:00 AM
7:15 AM
7:30 AM
7:45 AM
8:00 AM
8:15 AM
8:30 AM
8:45 AM
9:00 AM
9:15 AM
9:30 AM
9:45 AM
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
1:00 PM
1:15 PM
1:30 PM
1:45 PM
2:00 PM
2:15 PM
2:30 PM
2:45 PM
3:00 PM
3:15 PM
3:30 PM
3:45 PM
4:00 PM
4:15 PM
4:30 PM
4:45 PM
5:00 PM
5:15 PM
5:30 PM
5:45 PM
6:00 PM
6:15 PM
6:30 PM
6:45 PM
7:00 PM
7:15 PM
7:30 PM
7:45 PM
8:00 PM
8:15 PM
8:30 PM
8:45 PM
9:00 PM
9:15 PM
9:30 PM
9:45 PM
10:00 PM
10:15 PM
10:30 PM
10:45 PM
11:00 PM
11:15 PM
11:30 PM
11:45 PM
Incentive Differential Base Rate Addition
$0
$1
$2
$3
$4
$5
Submit Required Rate
Hours Guaranteed
Blocked Scheduling Available
Yes
No
Weekend Requirement
On Call Requirement
Floating Requirement / Locations
Certification Requirements (in addition to standard credentials)
Years Experience Required
0
1
2
3
4
5+
Unit Information / Patient Population
Nurse / Patient Ratio
Number of Beds
EMR Used
Dress Code (business professional, business casual, scrub color, etc.)
Orientation Dates and Additional Information
On Site Testing Required
No
Yes
What Testing
Requested By
*
Request Authorized By
*
Submit Candidates To (name and email)
*
Additional Notes
Email
Submit
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