One Source Mobile Healthcare Clinical Services Representative
Application
Name
First Name
Middle Name
Last Name
Phone Number
E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
I meet the following requirements (check all that apply):
Passion for helping others
Professional Outlook
Willing to travel within 50 miles
Computer Literate
Reliable & Prompt
Works well with others
21+ years old
Clean driving record
Safe & insured vehicle
Ability to push patients in wheelchairs
Detail Oriented
Can legally work in the U.S.
Friendly Disposition
High School Degree or GED
Do You Own A Car?
Yes
No
Do You Have A Drivers License?
Yes
No
Distance Willing To Travel?
Please Select
Over 50 Mile Radius
Below 50 Mile Radius
Over 100 Mile Radius (bonus provided)
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Employment Desired:
Date You Can Start
-
Month
-
Day
Year
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Position Interested In (check all that apply):
Full Time
Part Time
Temporary
On Call
Applicant Availabilty
All shifts begin at 8:30 am and end between 4-5:00 pm
What is your availability for work?
Open Availability
1-3 days per week
3-5 days per week
Other
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Skills/Qualifications:
Introduce yourself by sharing a brief summary of your past experience. Include qualities that would make you an outstanding candidate for the position.
Important Note: We are looking for clinical representatives that can self-manage and understand the significance of working with individuals who have varying degrees of cognitive abilities. Additionally, we highly value professional letters written with attention to detail (grammar, punctuation, etc.).
List three words that describe your personality:
What skills and experience do you have that are useful for working in a healthcare role? Feel free to be as in depth as possible.
Anything else you would like to share:
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Education:
Highest Level of Education:
Please Select
High School
College
Graduate School
High School
Name of High School Attended
Graduated High School?
Please Select
Yes
No
College
Name of College/University Attended
Graduated College?
Please Select
Yes
No
In Progress
List of other professional training:
i.e. STARS, NCS, Doula training, conference workshops, etc.
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Mandatory Job History
Are you currently employed?
Yes
No
Current Employer Name
i.e. Name of Family
Current Employer Position
Your job title
Current Employer Start Date
-
Month
-
Day
Year
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Current Employer Location
i.e. Neighborhood
Current Employer Duties
Please include an in-depth job description
Previous Employer
i.e. Name of Family
Previous Employer Position
Your job title
Previous Employer Start Date
-
Month
-
Day
Year
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Previous Employer End Date
-
Month
-
Day
Year
Date Picker Icon
Previous Employer Location
i.e. Neighborhood
Previous Employer Duties
Please include an in-depth job description
Previous Employer Reason for Leaving?
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References:
Please include at least two
May we contact your references?
Yes
No
Reference One
Name of Reference
Reference One Relationship
Reference One Years Acquainted
Reference One Phone
Reference One Email
example@example.com
Reference Two
Name of Reference
Reference Two Relationship
Reference Two Years Acquainted
Reference Two Phone
Reference Two Email
example@example.com
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Cover Letter & Resume:
Please Upload Your Cover Letter
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Please Upload Your Resume
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Acknowledgement
I have uploaded my resume. Without a resume, I understand that my application may not be considered.
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