Application
  
 
Practicare Medical Management Inc., Online Application
Step 1 of 3:
Today's Date: May 10, 2008
Please indicate how you learned of job opportunities with Practicare Medical Management Inc.:
Employee Referral   Classified Ad   Government Agency   Random Search  
Practicare Literature    Trade Show/Event   Employment Agency  
Type of Work applied for:
Please State Your Availability for Work: Full Time    Part Time  
Hours and Days Available:
Have you ever completed an application to work here before?   Yes   No
If yes, when?
Have you ever worked here before? Yes  No
If yes, when and what department?
Date you can report for work (Day /Month /Year)
Desired Salary
PERSONAL
Last Name:First Name:Middle Initial:
Address:
Street 
City     State   Zip  
Home Phone:  
Number to contact you during working hours:  
Email:  
Do you have the legal right to seek employment in the United States? Yes No
Are you at least 18 Years of Age? Yes No
Have you ever been convicted of a criminal offense? (Exclude Traffic Violations) Yes  No
If yes, please explain.
Education
College, University, Professional or Technical School
Name of High School
Address
Were you graduated?
Yes    No
Type of Diploma
Major
Minor
Class Standing or Grade Average:
Name of Undergraduate College
Address
Were you graduated?
Yes    No
Type of Degree
Major
Minor
Class Standing or Grade Average:
Name of Graduate College
Address
Were you graduated?
Yes    No
Type of Degree
Major
Minor
Class Standing or Grade Average:
Other Schools or Additional Training:
Name of Institution
Address
Were you graduated?
Yes    No
Type of Degree
Major
Minor
Class Standing or Grade Average:
Do you have a high school equivalency diploma?
Yes    No
If Yes, date received:
Issuing Agency:
Please Indicate below if you have any of the following skills:
Typing   WPM   Customer Service    Data Entry  
Telephone Calls    calls/day    Spreadsheet   Word Processing  
 
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