Non-Clinical Employment Application

Employment Application
This application is designed to help us understand how you think, work, and perform in a structured, high-accountability environment. To achieve the best results, take your time to read each question carefully and provide clear, honest, and complete responses.

Many questions are scenario-based and intended to reflect real situations you may encounter in this role, so thoughtful answers matter. Before you begin, ensure you have your resume, relevant certifications, and work history readily available.

A well-prepared application not only improves your evaluation outcome but may also allow us to move forward in the process more efficiently.
SECTION 1 — INTRODUCTION
Purpose of This Application

This application is not just a form—it is a structured pre-screening assessment used to evaluate:

• Your professional experience and role readiness
• Your ability to operate in a structured, KPI-driven environment
• Your alignment with Impireum’s Trust and Performance culture
• Your attention to detail and ability to follow instructions

👉 A strong application may reduce or eliminate the need for an interview.
SECTION 2 — APPLICATION INSTRUCTIONS (MANDATORY ACKNOWLEDGEMENT)

Required Checkbox (MUST SELECT TO CONTINUE)
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 proceedingType option 4
SECTION 3 — POSITION SELECTION (DYNAMIC DRIVER)
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
YesNo
3. Birth Date*

MonthDayYear
YesNo
MaleFemaleOther
9. Date You Can Start*

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

Browse Files

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SECTION 6 — ROLE-SPECIFIC EXPERIENCE (DYNAMIC)
NEUROFEEDBACK TECHNICIAN
YesNo
YesNo
YesNo
📎 Neurofeedback: Training/Certification (if applicable)

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

Browse Files

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

Browse Files

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PRACTICE MANAGER
YesNo
YesNo
YesNo
📎 Manager: Leadership Resume / Supporting Documents

Browse Files

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DIRECTOR OF OPERATIONS
YesNo
YesNo
YesNo
Director: Leadership Resume / Supporting Documents

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SECTION 7 — KPI & PERFORMANCE ASSESSMENT
12345678910
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
12345678910
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
Full-TimePart-Time
EveningsWeekendsBoth
YesNo
SECTION 11 — FINAL CERTIFICATION
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
12A. High School*
Name of High School Attended
YesNo
12C. Graduation Date:*
12D. College*
Name of College/University Attended
12E. Number of Years Attended*
12F. Area of Study/Degree*
YesNo
12H. Graduation Date:*
12I. Graduate School*
Name of Graduate School Attended
12J. Number of Years Attended*
14K. Area of Study/Degree*
YesNo
12M. Graduation Date:*
SECTION 13 — EMPLOYMENT
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?*
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*
YesNo
American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Signature*
Should be Empty:

Employment Application

SECTION 1 — INTRODUCTION

SECTION 2 — APPLICATION INSTRUCTIONS (MANDATORY ACKNOWLEDGEMENT)

SECTION 3 — POSITION SELECTION (DYNAMIC DRIVER)

SECTION 4 — PERSONAL INFORMATION

SECTION 5 — DOCUMENT UPLOAD (HARD GATE)

SECTION 6 — ROLE-SPECIFIC EXPERIENCE (DYNAMIC)

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