Front Desk Job Application Form

Front Desk Assistant Application

1825 W. Stadium Blvd. Ann Arbor | 734-222-1492 | rshc@steinerhealth.org
Job Description

Non-profit medical practice with standard and alternative medicine, treating children and adults with many different conditions. The receptionist is responsible for checking patients in and out, scheduling follow-ups and new patients, creating invoices on Quickbooks and taking payment. Proper care of patient charts, inventory of medicines and over-the-counter remedies, and keeping the office clean. Attending to phonecalls and faxes, mailing medicines to patients.

Job Type: Part-time

Hours per week: Variable, 20-24

Starting Pay: $16.00 - $18.00 per hour
Full Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
Phone Number
Available Start Date

MonthDayYear
Date
Highest level of education completed:
College Major: Blank
Are you authorized to work in the U.S.?

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Have you ever been convicted of a felony?

YesNo
Professional Reference (Supervisors, not friends or coworkers):
First Name   Last Name , Relationship , Company
Contact:   Phone Number  and Email  .

Second Professional Reference:
First Name   Last Name ,Relationship ,Company
Contact:   Phone Number   andEmail

Most recent previous employment: Blank at   Company .
Started:   Date   Ended:   Date
Starting Pay:Blank ending pay:   Blank
Reason for leaving:   Blank
Supervisor:   Name   can be contacted at:  Phone Number . May we contact this supervisor?   Yes   No

Next most recent employment:Job Title at   Company .
Started:   Date   Ended:   Date
Starting Pay:Blank , ending pay:Blank
Reason for leaving:Blank
Supervisor:Name  can be contacted at:   Phone Number . May we contact this supervisor?   Yes   No
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Front Desk Assistant Application

Job Description