Medical Assistant Job Application

Instructions: Please complete this application and attach any additional pages, such as a resume or vita and letters of recommendation.
Position applying for:
Hours per week available:
Why do you want to work at White Bird? In a collective?
How would you work with a large, unruly, slightly crazy, and occasionally unreliable group of volunteers?
Given the job description, please provide any information about yourself that will help us in making a decision.
Name:
Phone:
Address:
Driver's license (if applicable to job posting):
Date available:

Month Day Year
Date
List three references, their addresses, phone numbers and occupations:
1.
2.
3.
I authorize White Bird Clinic to contact any sources and references to verify and obtain information in assessing my qualifications unless otherwise specified on the application. I certify that all my statements on this application are true.
Signature:

Clear
Date:

Month Day Year
Date
If you have a resume and/or cover letter, use the following to search your file system for those documents.

Browse Files

Cancel of
Contact Email
example@example.com
Should be Empty: