Sinai Adult ED, Sinai Peds ED & BI Urgent Care ED and Brooklyn Moonlighting Submission Form
To get paid, please submit your Mount Sinai Hospital Adult, Peds and BI 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, DO NOT USE THIS FORM. Instead, please e-mail Donna at donna.smithjordon@mountsinai.org.

For Epic support staff moonlighting at MS Brooklyn, MSW or MSSL, DO NOT USE THIS FORM. Instead, please email Danielle at danielle.kaufman@mountsinai.org.

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