Job Opening: Receptionist – Daphne Full time days in Daphne office. Monday through Friday. Medical office experience preferred. Experience with EMR preferred. Must have stable work history (2+ years). Posted November 20, 2023 APPLICATION FOR EMPLOYMENT Answer all sections completely. Full Name Previous names, maiden name Address City State Zip Social Security Number Email Phone (Day) Evening: Other: Are you going to school within the next 12 months? YesNo Do you have friends or relatives working for Premier Medical? YesNo Name Relationship How did you hear about us? Employment History Company Name Phone Address City State Zip Dates of Employment (From) (to) Position was: Full-timePart-time Position Salary Reason for Leaving Supervisor Name Company Name Phone Address City State Zip Dates of Employment (From) (to) Position was: Full-timePart-time Position Salary Reason for Leaving Supervisor Name Company Name Phone Address City State Zip Dates of Employment (From) (to) Position was: Full-timePart-time Position Salary Reason for Leaving Supervisor Name Education Name of High School City State Zip Diploma yesno Name of College or University City State Zip Graduated yesno Degree Name of College or University City State Zip Graduated yesno Degree Work References Name Title Company Name Phone Name Title Company Name Phone Name Title Company Name Phone Upload your resume here: Required Section Read this section carefully. Your signature certifies to these procedures. This application will remain active for 30 days. I understand that to be considered for employment after that time, I must complete a new application form. I certify that information given by me is true and correct. I understand that falsification or omission of any information on this form or in a personal interview may result in my termination, whenever discovered by the Company. I authorize the Company to make such investigations of my employment, financial, medical and other history as it deems necessary. I also authorize my past and present employers, schools and all other persons to respond fully to any such inquiries from the Company, and I release all such persons from any liability in responding to such inquiries. I understand that I may be subject to a pre-employment medical screening, after receiving a conditional offer of employment, and must meet the qualifications for the positon, with or without accommodation, before being permitted to commence work. I understand employment is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States. If employed, I agree to abide by all rules, policies and procedures of the Company. I understand and agree that, if employed, my employment is at-will, for no definite or permanent duration, and may be terminated by either me or the Company at any time without notice or cause. I understand that no one has any authority to change these terms of my employment, or to make any contrary agreement with or promises to me, except in writing by the Chief Executive Officer. I Agree Signature Date WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Federal laws and regulations prohibit discrimination in employment practices based on age, race, religion, sex, national origin, military status, disability or sexual preference. Premier Medical Group, Inc complies with the American with Disabilities Act and offers reasonable accommodations to all qualified persons with disabilities.
