Job Applications: Regional Cardiology Associates, P.L.C

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Employment Application

Regional Cardiology is an Equal Opportunity Employer. All applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non-related medical condition or handicap.

Date*
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email Address*
Position Applying For*
If not applying for specific position, please put "Other."
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?*
- Yes
- No
Do you have any friends, relative, or acquaintances work for the company?*
- yes
- No
If yes, state name and relationship*
If not applicable, please put N/A.
If under age 18, can you provide proof of your eligibility to work?*
- yes
- no
Have you been convicted of a felony in the past 7 years?*
- Yes
- No
If convicted, describe the crime - state of nature of crime(s), when and where convicted and disposition of case.*

If not applicable, please put N/A.
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)*
- Agree
Have you applied here before?*
- Yes
- No
If yes, When? Position Applied for?*
If not applicable, please put N/A.
How did you learn about us?*
If hired, what date are you available to start?*
What hours are you available?*
Are you available for overtime?*
- Yes
- No
Are you seeking:*
- Full time
- Part time
- Contingent
- Temporary
Are you currently employed?*
- yes
- No
May we contact your present employer?*
- Yes
- No
What hourly wage of salary are you seeking?*
Employment Experience
Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, relgion, sex, or national origin.
Employer 1*
Address*
Street Address City State ZIP Code
Phone*
Supervisors' Name*
Job Title*
Briefly summarize assigned objectives and responsibilities.*
Reason for leaving*
Dates of employment*
Salary or Hourly rate*
Employer 2
Address
Street Address City State ZIP Code
Phone
Supervisors' Name
Job Title
Briefly summarize assigned objectives and responsibilities.*
Reason for leaving
Dates of employment
Salary or Hourly rate
Employer 3
Address
Street Address City State ZIP Code
Phone
Supervisors' Name
Job Title
Briefly summarize assigned objectives and responsibilities.*
Reasons for leaving
Dates of employment
Salary or Hourly rate
Education:
Schools/Colleges Attended:

Schools/Colleges Attended:*

School	# Years	Year Grad	Degree

Schools/Colleges Attended:
School # Years Year Grad Degree
Schools/Colleges Attended:
School # Years Year Grad Degree
Field of Study:*
Professional References
Do not list friends or family
*
Name Phone #
Name Phone #
Name Phone #
Describe any special qualifications for this job:*
Are you a veteran of the U.S. Milliary service?*
- Yes
- No
Upload Cover Letter & Resume
Drop files here or
I hereby certify that the facts set forth in the completed employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application may result in dismissal. I release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. You are hereby authorized to make any investigation of my personal history academic/professional credentials, military service records, criminal, driving, financial and credit record through any investigative or credit bureaus of your choice. This application for employment shall be considered active for a period of time not to exceed 90 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 also 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 Employee may resign at any time and 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. I hereby certify that the facts set forth in the completed employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application may result in dismissal. I release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. You are hereby authorized to make any investigation of my personal history academic/professional credentials, military service records, criminal, driving, financial and credit record through any investigative or credit bureaus of your choice. This application for employment shall be considered active for a period of time not to exceed 90 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 also 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 Employee may resign at any time and 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.*
- Agree
Name of applicant*
Date*

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Schedule your appointment today! 3399 Pollock Rd. #A Grand Blanc, MI 48439 (810) 603-0170 Toll Free: (800) 822-2012

Contact Info x

Employment Application

Employment Experience

Education:

Professional References

Schedule your appointment today!
3399 Pollock Rd. #A

Grand Blanc, MI 48439
(810) 603-0170
Toll Free: (800) 822-2012