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.::Maryland Client Request Application::.

You, Unit Managers, Allocations Officers and staff can now book shifts online!

In addition to phone bookings, now offers our clients the convenience of booking shift requests online. This can save you valuable time in your busy day.

It’s easy, simply complete the form below then click on the submit button for Maryland Residents. A representative will then call your department to confirm your request and availability of staff. If you prefer to submit your requirements by phone you can do so by phoning Kahak Health Care Services.

CLIENT DETAILS
Clients name
Name of Person
Position
Contact Number
Email Adress
 
SHIFT AVAILABILITY DETAILS
1 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
2 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
3 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
4 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
5 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
6 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
7 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
8 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
9 Start date
End date
Classification
AM
PM
ND
Number Need Location
 
 Additional information
             

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