Application for employment
Name
*
First Name
Last Name
Date available to start:
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
Feel free to leave this blank if you would prefer
Mobile Phone Number
Feel free to leave this blank if you would prefer
Format: (000) 000-0000.
Position applying for
*
Please Select
Front Desk/Reception
Ophthalmic technician
Optician
Contact Lens technician
Other
Do you have any degrees or certifications
Please Select
Doctor of Optometry (O.D.)
Contact lens certification (NCLE)
Certified Paraoptometric (CPO, CPOA, or CPOT)
Certified Optician (ABO)
Master Optician (ABOM)
Medical Billing
BS, BA, BBA
MBA or other Medical Degree
What salary range would meet your expectations for this position? ( in dollars per hour).
What interests you about the position you are applying for? (you can select more than one)
Location
Salary
Benefits
Hours
Work environment
Other
What was the most frustrating part of your current role? What steps have you taken to make this part of your role less frustrating?
Why would you consider leaving your current job/ or why did you leave your previous job?
What values of your previous/current employer most align with yours and what would you have changed?
What responsibilities do you hope to have with our office?
What skill are you still missing to perform the role you are applying for?
Tell us anything you'd like us to know about yourself that would make you stand out against other applicants.
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