Non-Clinical Employment Application

Non-Clinical Employment Application
SECTION 1 — INTRODUCTION
Welcome and thank you for your interest in joining Impireum

This application serves as a structured pre-screening to identify candidates who align with our standards of trust, performance, and results. Each section is an opportunity to demonstrate your professionalism and fit.

To streamline your experience, we strongly recommend reviewing the Employment Application Guide before starting. Note that most candidates complete the application in ~10 minutes with it.

A strong submission may accelerate your progression and reduce the need for a formal interview.

We look forward to learning more about you.
SECTION 2 — APPLICATION INSTRUCTIONS

Required Checkbox (MUST SELECT TO CONTINUE)
MANDATORY ACKNOWLEDGEMENT:*

I confirm that I have read the Impireum Employment Application GuideI understand that incomplete applications will not be consideredI understand that required documents must be uploaded before proceeding
SECTION 3 — POSITION SELECTION
Position Applying For*
(Select One)
SECTION 4 — PERSONAL INFORMATION
5. First Name:*
5. Last Name:*
7. Phone Number:*
8. Email*

Confirmation Emailexample@example.com
6. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Willing to work in multi-state environment?*

YesNo
3. Birth Date*

MonthDayYear
4. Are You a U.S. Citizen?*

YesNo
5. Gender*

MaleFemaleOther
9. Date You Can Start*

MonthDayYear
10. Have You Worked Here Before?*

YesNo
SECTION 5 — DOCUMENT UPLOAD
📎 Resume / CV (REQUIRED)*

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SECTION 6 — ROLE-SPECIFIC EXPERIENCE
NEUROFEEDBACK TECHNICIAN
Experience with EEG or neurofeedback systems?*

YesNo
Comfort working with behavioral health patients?*

YesNo
Experience following structured protocols?*

YesNo
📎 Neurofeedback: Training/Certification (if applicable)

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MEDICAL ASSISTANT
Experience in outpatient/behavioral health setting?*

YesNo
Vitals, intake, and patient flow experience?*

YesNo
EMR experience (eCW preferred)?*

YesNo
📎 Medical Assistant: Certification (CMA/RMA if applicable)

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BILLING / RCM
Experience with claims submission and denial management?*

YesNo
Familiarity with payer guidelines?*

YesNo
Experience reducing AR days?*

YesNo
📎 Billing/RCM: Certifications (CPC, CRC, etc.)

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PRACTICE MANAGER
Experience managing clinic operations?*

YesNo
Staff oversight experience?*

YesNo
Experience with KPI tracking and reporting?*

YesNo
📎 Manager: Leadership Resume / Supporting Documents

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DIRECTOR OF OPERATIONS
Multi-site leadership experience?*

YesNo
Experience scaling operations?*

YesNo
Experience managing managers?*

YesNo
Director: Leadership Resume / Supporting Documents

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SECTION 7 — KPI & PERFORMANCE ASSESSMENT
Rate your experience with performance-based environments:*

12345678910
Have you worked in a KPI-driven role before?*

YesNo
Admin
Admin
Scheduling accuracy (%)*
Call handling experience*
RCM
Clean claim rate (%)*
AR days managed*
Manager:
Team KPI performance tracking*
Revenue oversight*
SECTION 8 — TRUST & PERFORMANCE SELF-ASSESSMENT
Rate yourself (1–10): Trust (accountability, reliability, professionalism)*

12345678910
Rate yourself (1–10): Performance (productivity, results, outcomes)*

12345678910
Short Answer:Describe a time you were held accountable for performance. What was the outcome?*

0/500
SECTION 9 — SCENARIO-BASED QUESTIONS
A patient/client is dissatisfied with service. What do you do?*

0/500
A claim is denied repeatedly. What steps do you take?*

0/500
Your team is underperforming KPIs. How do you respond?*

0/500
SECTION 10 — AVAILABILITY & COMMITMENT
Desired Start Date:*

MonthDayYear
Date
Desired Employment:*

Full-TimePart-Time
Willing to work evenings/weekends*

EveningsWeekendsBoth
Willing to work multiple state operations?*

YesNo
SECTION 11 — FINAL CERTIFICATION
Required Agreement*

I certify that all information provided is accurateI understand this application serves as an evaluationI understand failure to meet KPI expectations may impact employment
SECTION 12 — EDUCATION AND TRAINING
Highest Level of Education Completed*
Select the highest level completed so the next education questions can adjust based on your answer.
Equivalent experience, certifications, and demonstrated performance may also be considered for many non-clinical roles.
Education details will be collected based on the level selected above, including school or program name, city/state, completion status, years attended, area of study, credentials earned, and completion dates where applicable.
12A. High School
Name of High School Attended
12B. Did You Graduate?

YesNo
12C. Graduation Date:
12D. College
Name of College/University Attended
12E. Number of Years Attended
12F. Area of Study/Degree
12G. Graduated?

YesNo
12H. Graduation Date:
12I. Graduate School
Name of Graduate School Attended
12J. Number of Years Attended
14K. Area of Study/Degree
12L. Graduated?

YesNo
12M. Graduation Date:
SECTION 13 — EMPLOYMENT
13A. Currently Employed*

YesNo
13B. Start Date*

MonthDayYear
13C. Current Employer*
Name of Current Employer or NONE if not Employed
13D. Position*
13E. Salary*
13F. Reason for Leaving?*
13G. May We Contact?*

YesNo
13H. Skills*
List any relevant skills
13I. Other Qualifications*
List any other relevant certifications or qualifications
SECTION 14 - References
14A. Reference 1*
Name of Reference
14B. Relationship*
14C. Phone*
14E. Years Acquainted*
14F. Email*
14G. Reference 2*
Name of Reference
14H. Relationship*
14I. Phone*
14J. Years Acquainted*
14K. Email*
14L. Reference 3*
Name of Reference
14M. Relationship*
14N. Phone*
14O. Years Acquainted*
14P. Email*
15. Are you Hispanic or Latino?*

YesNo
16. Regardless of your answer to the prior question, please indicate how you identify yourself. (Select one or More)*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Signature*
Education Score
Education Role Alignment
Multi State Score
Tech Score
VA Score
KPI Score
Judgment Score
Compliance Score
Culture Score
Role Specific Fit Score
Availability Score
Total Score
Candidate Tier
Auto Recommendation
Auto Flag
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Non-Clinical Employment Application

SECTION 1 — INTRODUCTION

SECTION 2 — APPLICATION INSTRUCTIONS

SECTION 3 — POSITION SELECTION

SECTION 4 — PERSONAL INFORMATION

SECTION 5 — DOCUMENT UPLOAD

SECTION 6 — ROLE-SPECIFIC EXPERIENCE

NEUROFEEDBACK TECHNICIAN

MEDICAL ASSISTANT

BILLING / RCM

PRACTICE MANAGER

DIRECTOR OF OPERATIONS

SECTION 7 — KPI & PERFORMANCE ASSESSMENT

Admin

RCM

Manager:

SECTION 8 — TRUST & PERFORMANCE SELF-ASSESSMENT

SECTION 9 — SCENARIO-BASED QUESTIONS

SECTION 10 — AVAILABILITY & COMMITMENT

SECTION 11 — FINAL CERTIFICATION

SECTION 12 — EDUCATION AND TRAINING

SECTION 13 — EMPLOYMENT

SECTION 14 - References