Sinai Adult & Peds ED Moonlighting Submission Form
To get paid, please submit your Mount Sinai Hospital Adult and Peds Moonlighting information on this form.

If you have any issues getting paid for MSH moonlighting, please contact Marisol at marisol.xelo@mountsinai.org.

For Mount Sinai Queens (MSQ) moonlighting submissions DO NOT USE THIS FORM. Instead, please e-mail Donna at donna.smithjordon@mountsinai.org.

Name: *
Your answer
Life Number: *
Your answer
Date of Your Moonlighting Shift: *
(If Overnight: Date Shift Started)
MM
/
DD
/
YYYY
Shift Start Time: *
Time
:
Shift End Time: *
Time
:
Shift Duration in Hours *
Your answer
Location: *
Payment Preference: *
Submit
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