Clearview Dermatology Employment Application Form

Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
E-mail Address:*
What position are you applying for?*

Medical AssistantPatient ServicesOther
How were you referred to us?*

Walk-InEmployeeIndeedWebsiteFacebookOther
Upload Resume:*
Are you currently enrolled or planning to enroll in further education or certifications?*
Please explain.
Have you applied before?*

YesNo
Have you worked here before?*

YesNo
Are you over 18?*

YesNo
Do you have reliable transportation?*

YesNoOther
Are you legally authorized to work in the United States?*

YesNo
Are you related to a current or former employee here?*
If yes, please list the employee's name, and relationship to you. If no, type N/A*
Are you looking for full or part time?*

Full time (4-5 8-10 hour shifts/week)Part-time (1-3 shifts/week)
Please check off days of the week you are AVAILABLE to work?*

MondayTuesdayWednesdayThursdayFriday
Please indicate your availability for a phone/virtual interview?*

Monday 9am-12pmTuesday 9am-12pmWednesday 9am-12pmThursday 9am-12pmFriday 9am-12pmMonday 1-3pmTuesday 1-3pmWednesday 1-3pmThursday 1-3pmFriday 1-3pmOther
Please select the best option for a virtual interview?*

FacetimeZoomOther
Briefly explain what skills/experience you have that would be a good fit for this position?*
What is your salary range?*
We have offices in 3 locations. Please indicate which location(s) you are interested in. (Select all that apply).*

Leominster, MAHudson, MAGardner, MA
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