Healthcare Candidate Application Form
Apply to be placed by Selara LLC -- Michigan's Healthcare Staffing & Recruiting Firm
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
*
State
*
Current Employment Status
*
Please Select
Employed
Unemployed
Student
Other
Job Title
*
Medical Billing & Coding Specialist
Medical Administrative Assistant
Front Desk Receptionist
Patient Access Representative
Prior Authorization Specialist
Medical Records Specialist
Revenue Cycle Specialist
CNA
LPN
Medical Assistant (MA)
Phlebotomist
Patient Care Technician (PCT)
Other
Years of Experience
*
Please Select
0-1
2-3
4-5
6-7
8-9
10+
Work Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Employment Preference
Full Time
Part Time
Temp to Hire
Preferred Shift or Work Hours
Please Select
Morning
Afternoon
Evening
Night
Flexible
Sponsorship Information
Do you currently require sponsorship or anticipate needing sponsorship in the future?
*
Yes, currently require sponsorship
No, do not require sponsorship
No, but may require sponsorship in the future
Upload Typing Test Screenshot For Administration Roles
Upload a File
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Choose a file
Please note: The typing test must be completed on a laptop. Goal for Admin Roles: 30-35 WPM Website: https://www.typingtest.com/
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Upload Your Updated Resume
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Please ensure your resume is easy to read and up to date
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Candidate Agreement
Please Read Before Submitting
SELARA HEALTHCARE STAFFING & RECRUITING— CANDIDATE AGREEMENT By submitting this application, you acknowledge and agree to the following terms and conditions: 1. Commitment to Placement I understand that Selara LLC will invest time and resources into finding me employment. I am serious about securing a position and will not withdraw from consideration or decline an accepted offer after a placement has been successfully made on my behalf. 2. 90-Day Commitment I understand that if I am placed in a position, I am expected to remain in that role for a minimum of 90 days from the start date. I agree not to request or schedule non-essential time off (vacation, personal days) during my first 90 days of employment unless there is a documented medical or family emergency requiring my absence. 3. Communication Requirements I agree to respond to all calls, texts, and emails from Selara LLC regarding my application or placement process within a 24-hour window. Failure to adhere to this communication requirement may result in my immediate removal from consideration for current and future opportunities. 4. Honesty and Accuracy I certify that all information provided in this application, including my resume, references, and interview statements, is true, accurate, and complete. Falsification, misrepresentation, or omission of any material information will result in immediate disqualification and termination of this agreement. 5. Professional Conduct I agree to represent myself professionally and ethically in all interviews, assessments, and workplace interactions arranged through Selara LLC. This includes being punctual, prepared, and courteous to potential employers and their staff. 6. No Fee to Candidates I understand and acknowledge that Selara LLC provides placement services to candidates at absolutely no cost. Selara LLC does not, and will never, charge candidates a fee for finding employment. Selara LLC reserves the right to decline representation to any candidate at any time, for any reason.
Scroll to the bottom to read the full terms and conditions.
TERMS AND CONDITIONS
I have read and agree to all of the terms and conditions of the candidate agreement above.
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