Gwinnett Clinic Application - Phase I

Name*

First Last

Resume*

Drop files here or

Max. file size: 50 MB, Max. files: 3.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

How did you hear about us?*

What position you are applying for?*

Patient Care Representative
Medical Assistant / Nurse
Other

Please choose all that apply.

If other, please note here:

Office Skills

Please choose all that apply.

What is your typing speed?*

If you are unsure, please go to www.typingtest.com/ScoreTrim/ on a desktop or laptop to find out your WPM (words per minute).

Technical Skills / Lab Work

Please check all that apply.

If you selected "Injections" above, please specify the name(s) of the injection(s) you've done:

Other Relevant Skills

Bone Density
X-Ray
Other

If other, please note here:

Are you looking for a full-time or part-time position?*

Full-time: 30-40 hrs / week, you will be required to work 4 weekend days out of every 4 weeks, generally 2 Saturdays and 2 Sundays Part-time: 24 hrs or less, no weekend requirement

Full-time
Part-time
Either

Please indicate the hours you are available to work.*

Select all that apply. Please keep in mind: ** Full-time: 30-40 hrs / week, you will be required to work 4 weekend days out of every 4 weeks, generally 2 Saturdays and 2 Sundays. ** Part-time: 24 hrs or less, no weekend requirement.

Are you currently working?*

Yes
No

Why are you looking for a new position?*

Can you tell us about some of your daily tasks and responsibilities at your current position?*

Why did you leave your previous position?*

Can you tell us about some of your daily tasks and responsibilities at your last position?*

Please explain below if you have changed jobs more than once a year.

Where do you see yourself in 5 years? (100 words or less)*

What is your motivation for working in health care?*

When would be your potential start date?*

How many miles are you comfortable traveling?*

We have 19 locations in and around Gwinnett County. See them here: www.gwinnettclinic.com/our-locations/

What is your salary expectation per hour?*

Please give a range.

Our payroll is every 4 weeks, meaning you will be paid every 28 days.*

Please initial for acknowledgement.

Please review our mission, values, and core principles using the link below. Why would you be a good fit?*

www.gwinnettclinic.com/about/our-mission/

Anything else you would like us to know? Example: relocating, availability (if you are in school), etc.

I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false statements may result in denial or future termination of the position. Please e-sign below.*

Name

This field is for validation purposes and should be left unchanged.

Gwinnett Clinic Application – Phase I

Let us take care of you.