Language
English (US)
JOB APPLICATION
Full Name
*
First Name
Middle Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Applying for Position
*
Dental Billing Analyst
Medical Billing Analyst
Start date
*
-
Month
-
Day
Year
Date
Upload Resume
*
Upload a File
Resume and/or Cover Letter
Cancel
of
References
Upload a File
References
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of
Are you a U.S. Citizen?
*
Yes
No
Are you authorized to work in the U.S.?
*
Yes
No
Do you have experience in the position you are applying for?
*
Yes
No
I understand that the position I'm applying for is located in Olympia, WA
*
Yes
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Certifications
Do you have any certifications?
Yes
No
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Certifications Information
Type of Certification
Name of Certifying Body
Date Received
-
Month
-
Day
Year
Date
Date of Expiration
-
Month
-
Day
Year
Date
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Disclaimer
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
*
I agree
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