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Urgent Care Facility Serving the Flagstaff Arizona Community
APPLICATION FOR EMPLOYMENT
Name
*
First Name
Last Name
Email
*
Phone Number
*
Select position(s) you are applying for:
*
Front Desk Receptionist
Medical Assistant
What is your availability?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Times you are available to work?
*
example: 8-4 Mondays, 9-2 Sundays
Are you looking for PT or FT?
*
Part Time
Full Time
Did you graduate from High School?
*
Please list when and where you attended
Most recent Employment:
Name of Company
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Position(s) held:
Describe your duties:
Dates of Employement
Reason for Leaving
May we contact your previous employer?
Yes
No
If yes, whom should we ask for?
Have you ever been convicted of a felony?
*
Yes
No
If yes, please explain:
Why are you applying for this position?
*
What is your pay rate expectation?
Please list why this job would be a good fit for you?
Include any special skills, hobbies, experience, etc.
Thank you! Your application has been successfully submitted.
