Employment

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Personal Information

Name:

Date:

Address:

Email:

Phone:

Position(s) Desired:

Can you perform the essential functions of the position for which you are applying?

Yes

If no, please explain.

Date available to work?

Are you over the age of 18 years?

Yes

Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment)

Yes

Have you every worked for this Company before?

Yes

If yes, where, when, and your job title:

Do you have any relatives or friends who work for the Practice or Surgery Center?

Yes

If yes, who and where do they work?

Have you ever done any volunteer work? YES [ ] NO [ ] If yes, describe: (Omit any volunteer work which reflects your race, color, religion, age, sex, sexual orientation, marital status, disabilities or any protected class)

Resume:

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Work Availability

Times Available on Days:

Are you currently employed?

Yes

If yes, may we contact your employer?

Yes

If currently employed, why are you considering leaving?

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Education (Type N/A if not applicable)

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College (Name and Location of School, Course of Study, Years, Diploma/Degree)

Vocational/ Trade School l (Name and Location of School, Course of Study, Years, Diploma/Degree)

Graduate Work (Name and Location of School, Course of Study, Years, Diploma/Degree)

Have you completed any special courses, seminars and/or training directly related to the position for which you are applying?

Yes

If yes, please describe:

List academic honors, extracurricular activities, offices held, etc. in high school or college: (Omit any which reflects your race, color, religion, age, sex, sexual orientation, marital status or disabilities.)

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Employment (Start with your current or most recent position)

Describe the Work Performed:

Describe the Work Performed:

Describe the Work Performed:

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References

Name | Occupation | Address | Phone

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.*

Please read carefully before signing. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Abilene Eye Institute Cataract & LASIK Surgery Center to hire me. If I am hired, I understand that either Abilene Eye Institute Cataract & LASIK Surgery Center or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Abilene Eye Institute Cataract & LASIK Surgery Center has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Abilene Eye Institute Cataract & LASIK Surgery Center true and complete information on this application. No requested information has been concealed. I authorize Abilene Eye Institute Cataract & LASIK Surgery Center to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

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employment

Employment Application