STANDARD APPLICATION FOR EMPLOYMENT
Welcome to Twin Cities Cardiology! We are hiring. Apply for upcoming positions as a Physician, Advanced Practice Provider, Nurse, Medical Assistant, Nursing Assistant, Echocardiographer, Vascular Ultrasonographer, or Front Desk staff, please fill out the form below. We are excited to hear from you!
Position applying for
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Please Select
Physician (MD or DO)
Advanced Practice Provider (NP or PA)
Nurse (RN or LPN)
Medical Assistant (RMA or CMA)
Nursing Assistant
Echocardiographer
Vascular Ultrasonographer
Front Desk Staff
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
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You may opt out at any time - we promise not to spam you!
1. What are the hours you wish to work? Full Time or Part Time?
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2. Are you authorized to work in the U.S. on an unrestricted basis? Yes / No
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3a. Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment) Yes / No
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3b. Please provide an explanation for 3a
Qualifications: please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.
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Rows
School Name
Degree
Address/City/State/Zip Code
Graduation Year
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2.
3.
4.
License / Credentials / Certifications: please list all.
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Rows
License / Credential
Year of Certification
State of Certification
Expiration of Certification
1.
2.
3.
4.
References: please list three professional references not related to you, with full name, address, phone number, and relationship. If you do not have three professional references, then list personal, unrelated references.
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Rows
Name
Address/City/State/Zip Code
Phone Number
Email
Relationship
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2.
3.
4.
Work History: start with your present or most recent employment and work back. Please fill in all entries for which you are comfortable. Include paid and unpaid positions.
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Rows
Job Title
Start and End Dates
Company Name
Supervisor Name and Number
Reason for Leaving
Salary
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2.
3.
4.
May we contact your present and former employees? Yes / No / NA
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Special Skills: list any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc)
How did you hear about us?
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I certify that the facts set forth in this application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this appplicatio. I acknowledge and understand that, unless otherwise specified, the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
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Type full name here as signature
Please verify that you are human
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Submit
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