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Application for Employment

What Position are you applying for?

Name:
First

Middle

Last

Address:
Street Address
Address Line 2
City
State
Zip Code
Best Contact Number
Email Address
Were you employed previously by us? YesNo



Position Details


Do you have your X-Ray License AND a Medical Assistant Certification? * YesNo
Have you worked in Urgent Care or an ER before? *? YesNo

 

Date available to start:
Current Hourly Amount*
Desired Hourly Amount*

 

Do you prefer: Part-TimeFull-TimePer Diem

 

Hours you cannot work
Select the method which best explains how you found out about this job*:

 

Resume
You may upload a doc or pdf file below.


File:*  

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