New Rate Request Contractor/Candidates's Name: Job Title: Client/Company Name: Work Location City: State: Contractor Hourly Rate: Desired Recruiter Rate: Job Category: Per-Diem Days:Choose One5 Day Rate7 Day RateDirect Patient Care:Choose OneYesNoRequester's Email:Choose Oneestrahl@galileosearch.comgsmith@galileosearch.comjimbrown@galileosearch.comklovejoy@galileosearch.comjtedesco@galileosearch.comAdditional Information: