Direct Hire Agency — Partnership Application – Mt. Sinai International Healthcare Staffing Group

Agency Partnership Intake Form (#5)

AGENCY PARTNERSHIP APPLICATION

SECTION 1:

AGENCY INFORMATION

Purpose: To identify your organization and establish a formal partnership profile.

Legal Business Name

Trading / Operating Name (if different)

Registered Business Address

Street Address

Suite No.

City / Town

State / Province / Parish

Postal / ZIP Code

Country

Official Website URL

Company Registration Number / Business License ID

Year Established

Type of Entity

Primary Industry Classification

(Please Specify)

SECTION 2:

PRIMARY CONTACT DETAILS

Purpose: To identify the principal point of contact for partnership communication.

Contact Person First Name

Contact Person Last Name

Job Title / Role

Direct Telephone Number

Direct Email Address

SECTION 3:

OPERATIONAL FOOTPRINT

Purpose: To understand your agency’s geographic coverage and recruitment capabilities.

Countries / Regions of Operation

Countries of Candidate Sourcing

Candidate Source Markets

Typical Annual Placement Volume

SECTION 4:

SERVICE SCOPE & SPECIALTIES

Purpose: To identify the professional categories and services your agency provides.

Professionals Recruited

Specialties Commonly Served (select all that apply)

Nature of Placements Provided

Other Specialties Commonly Served

SECTION 5:

COMPLIANCE & CREDENTIALING

Purpose: To verify the agency’s adherence to international recruitment and compliance standards.

Does your agency conduct primary source verification (PSV) of credentials?

Yes

Please describe your internal credentialing and verification process

Do you adhere to international ethical recruitment standards (e.g., WHO Code, CGFNS Alliance)?

Yes

In Progress

List any compliance or quality certifications held

SECTION 6:

PARTNERSHIP INTEREST

Purpose: To specify the intended nature of collaboration with MSI.

Type of Partnership Sought

What outcomes are you seeking through partnership with MSI?

Please specify what outcome are you seeking through partnership with MSI

Please Specify Type of Partnership Sought

Geographic Interest Areas

SECTION 7:

DECLARATION AND CONSENT

Purpose: To formalize the submission and authorize communication.

I hereby certify that the information provided in this form is accurate, complete, and true to the best of my knowledge. I acknowledge that submission of this form does not constitute a binding agreement, and that any formal partnership will be subject to further review and mutual consent.

Authorized Representative Name

Job Title

Date

I consent to be contacted by MSI Healthcare Staffing Group for partnership discussions and agree to the processing of my data in accordance with applicable data protection regulations.

Once completed, please review your information carefully.
Then, click the “Submit Application” button below to send your form to MSI Healthcare Staffing Group Partnership Division.

FOR DIRECT HIRING AGENCY— PARTNERSHIP Application Form