AOLA Client Proposal Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Facility Details Please provide your hospital or facility’s contact information.Facility / Hospital Name *Facility Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWebsite / URLPrimary Contact Name *FirstLastTitle / PositionWork Email *Phone Number *Recruitment Focus Tell us about your current staffing needs and specialties of interest. Which nursing specialties are you looking to fill?Med-SurgTelemetry / Step-DownICU / Critical CareER / EDOR / PerioperativeL&D / OBOtherList specialites *Number of positions needed *— Select Choice —1–56–1011–2020+Preferred start window for new hires *Are you currently hiring international nurses?SelectYesNoHave you previously worked with a recruitment agency? SelectYesNoIf yes, please describe your experienceChoose Your Package Select the partnership level that aligns with your facility’s goals.Packages *Founding Partner Package (Exclusive partnership, priority access, reduced rates)Standard Placement Package (Full-service direct hire – most popular)Premium Placement + Retention Package (Cohort hiring, relocation & mentorship support)Unsure — please recommend the best fitTell us about your current staffing goals so we can recommend the right package. *Additional Information Provide any extra details that will help us customize your proposal.Estimated nurse salary range offered (USD)Additional notes or questions for our teamHow did you hear about us? Select oneInstagramFacebookLinkedInTikTokGoogle SearchYouTubeFriend or Colleague ReferralNursing SchoolHospital or Employer ReferralWhatsApp/Telegram GroupWebinar or Live EventEmail NewsletterOnline AdvertisementNurse Influencer/Content CreatorOther recruitment are hiring Next Steps & Confirmation Please confirm your eligibility and consent before submitting your proposal request.Confirmations *I understand this form is confidential and for internal proposal purposes only.Request Proposal
