Employment Application s24
Total Page：16
File Type：pdf, Size：1020Kb
SCRIBE EMPLOYMENT APPLICATION
Name: Last, First Today’s Date:
Address: Street City State Zip
Contact info: Home Phone Cell Phone E-mail
No. of years Education: School name, location, year graduated completed Course of study GPA High School
College
Post Graduate School:
Do you plan to apply to a graduate school program (medical school, PA school, etc.)? If so, when (month/year) do you hope to start classes?
When would you like to start working as a scribe?
WORK EXPERIENCE: You must complete this section even if attaching a resume. Start with your current or most recent position, and account for all periods of employment (including full-time, part-time, and temporary) for the previous five years. Use additional pages if necessary. Fm: Mo / yr To: Mo / yr Starting salary: 1 Company: Final salary:
Address: May we contact your supervisor? Yes No Full-time Part-time Position: Supervisor’s name: Reason for leaving:
Duties: EXPLANATION: Phone number:
Fm: Mo / yr To: Mo / yr Starting salary: 2 Company: Final salary:
Address: May we contact your supervisor? Yes No Full-time Part-time Position: Supervisor’s name: Reason for leaving:
Duties: EXPLANATION: Phone number:
Fm: Mo / yr To: Mo / yr Starting salary: 3 Company: Final salary:
Address: May we contact your supervisor? Yes No Full-time Part-time Position: Supervisor’s name: Reason for leaving:
Duties: EXPLANATION: Phone number: EMPLOYMENT APPLICATION
References #1
Name:
Address:
Phone Number:
Relationship:
Permission to Contact:
#2
Name:
Address:
Phone Number:
Relationship:
Permission to Contact:
#3
Name:
Address:
Phone Number:
Relationship:
Permission to Contact: EMPLOYMENT APPLICATION
Questions: Why do you want to be a scribe?
What qualities and experiences do you possess that make you a competitive candidate?
What previous experience do you have in the medical field?
Are you comfortable using computers? What is your average typing speed (words per minute)?
How many hours per week would you like to work?
Do you have schedule restrictions?
If you are not chosen in this round, would you like to be considered in the future for a position as a scribe?