Employment Application Scheduling

Name: *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you learn about this position? *

On what day would you be available to start work? *

Are there any days or times you'd be unavailable to work? *

Do you have at least 2 years of experience working as a receptionist (or similar role) in a medical office setting? *

Yes No

Why do you think you make a good candidate for this position? *

Why do you want to work with Advanced Dermatology? *

Desired salary/wage? *

Do you require any special accommodations to perform the job for which you are applying? *

Yes No

Are you a U.S. citizen, or are you otherwise authorized to work in the U.S. without any restriction? *

Yes No

Have you ever been convicted of a crime or pled guilty to a criminal charge? *

Yes No

If yes, please describe: *

Have you ever been involuntarily terminated or asked to resign from any position of employment? *

Yes No

If yes, please describe: *

Have you taken illegal drugs in the last 30 days? *

Yes No

If selected for employment, are you willing to submit to a pre-employment drug screening test? *

Yes No

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. *

Yes, I give my electronic consent

Resume *

Max file size: 20MB

Cover Letter *

Max file size: 20MB

Employment Application - Reception