DOWNLOAD PHYSICIAN APPLICATION
Applications for the state you are interested in working are available here.  Please click on the applicable state and you will be able to download that application.  After completing the application, you can fax or mail it to:
 
Cynthia Weiss
Emergency Staffing Solutions
17304 Preston Road, Suite 555
Dallas, TX 75252
Fax Number:  972-934-3240
 
Faxing your application will speed up the credentialing process.  However, if you choose to fax your application, please keep in mind that we will need the original application as well for our records.
 
Copies of the following documents will also be required with your application:
 
All State Medical Licensure including DPS, DEA Certificate, ACLS, ATLS,
    PALS. BLS
Driver's License
CME's (for past 3 years)
Medical School Diploma
CV (current)
Board Certificate (if applicable)
Recent TB Test Results
 
For your convenience, if you complete the pertinent information on your application once, there is no need for you to duplicate this information.  Our credentialing staff will be happy to do this for you.
 
Thank you for your interest in ESS.  We hope you will join our team of dedicated professionals!
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For more great information about patient safety, risk management and performance solutions, please visit The Sullivan Group.

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