COMPLETE THE FORM TO SUBMIT YOUR REFERRAL

YOUR INFORMATION

First Name *

Last Name *

Your Profession *

Email Address *

Phone Number *

Your Specialty *

YOUR REFERRAL'S INFORMATION

Referral's First Name *

Referral's Last Name *

Referral's Profession *

Referral's Email Address

Referral's Phone Number

Referrals Specialty *

CV Attachment

Payout Terms:

$2000 total referral bonus for MDs/CRNAs

$1,000 paid out to the person giving the referral on day 1 of the new provider working

$1,000 paid out as a bonus incentive to the referee after working 10 shifts for us

$1000 total referral bonus for APPs

$500 paid out to the person giving the referral on day 1 of the new provider working

$500 paid out as a bonus incentive to the referee after working 10 shifts for us

A referral must meet the following criteria to qualify for payout:

- Referrals are valid for one year from submission.

- Only referrals for temporary locum tenens assignments will be considered eligible referrals; and Allied, RPO or permanent placement referrals shall not be eligible under this program.

- The referral reward does not apply for candidates who have been presented by a Health Carousel representative within the past 12 months or have worked for Health Carousel within the past 24 months.

- As the person providing the referral, to qualify the provider referred must work a minimum of one contracted day (or 8 hours) to be eligible for the payout.

- As the referred provider, to qualify you must work the required 10 shifts within 12 months of the referral to be eligible for the payout.

- Reward payment will be processed the following month after the required number of shifts have been worked. No partial payment will be made.

- Both parties must submit a W9 to Health Carousel if one is not already on file in order for payment to be processed.

- Client contacts, agencies or third-party vendors are not eligible for participation in this program.

- Health Carousel corporate employees or family members of a Health Carousel corporate employee will not be eligible to receive any rewards under this program