Employment Opportunities Referral Form

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may e-mail your response to this form to: onlinel@stanleyconsulting.ns.ca. Please feel free to fill out this online referral. You should expect a response within 1-2 days.
Please fill out the following information as it pertains to your employment requirements.
The private clinic web page has a link to the new employment opportunities page.
A charge of $10.00 will be sent to you by e-mail at the end of each month of posting.

Occupation Title:

Please post this position: or as of date listed below:

Term of Position?:

Date position is available: or as of date listed below:

Description of position:

Clinic Name:

Your Name:

Your Mailing Address:

City:

Province:

Postal Code:

Work Phone:

Work Fax:

What would be your preference for contact?: Phone     Fax     E-Mail

Length of time for web posting:

Your E-mail Address (Required):

Additional Comments:

A charge of $10.00 will be sent to you by e-mail at the end of each month of posting.

______________________________________________________________________

Occupation Title:

Please post this position:	or as of date listed below:

Term of Position?:

Date position is available:	or as of date listed below:

Description of position:

Clinic Name:
Your Name:
Your Mailing Address:
City:
Province:
Postal Code:
Work Phone:
Work Fax:
What would be your preference for contact?:	Phone Fax E-Mail
Length of time for web posting:
Your E-mail Address (Required):

Additional Comments:

A charge of $10.00 will be sent to you by e-mail at the end of each month of posting.