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Position Applying For:
Medical Transcriptionist
 
First Name
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Email
Phone
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Address
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State
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Preferred Job Type



Preferred Shift



I would consider other shifts
Are you eligible to work in the US?

Education Background

High School Name
High School Location
Name Used in HS if DIfferent than above
Did you Graduate High School
College
Degree
OtherEducationInfo

Licenses

Type


Issue Date


Number


Expiration


Millitary

Millitary Branch
Discharge Date
Rank at Discharge
Type of Discharge
ApplicableTraining

Employment History

Employer 1
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving
Employer 2
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving
Employer 3
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving

Criminal History

Have you ever been convicted of any felony or misdemeanor other than a minor traffic violation?

Offense Details

A conviction record will not necessarily disqualify you for employment. We do, however, perform criminal background checks and must take this into consideration when determining appropriate positions.

Applicant's Agreement

I understand that any employment with Alliance Health Documentation would not be for any fixed period of time and that if employed, I may resign at any time for any reason or Alliance may terminate my employment at any time for any reason in the absence of a specific written agreement to the contrary signed by the Chief Executive Officer of Alliance Health Documentation. I voluntarily consent to a thorough investigation of my past employment and activities. I give Alliance Health Documentation the right to make checks on my background and release from all liability or responsibility all persons, companies or corporations supplying such information. I understand that any false or incomplete answers or statements made by me on this application or any supplement thereto or in connection with the above mentioned investigations will be sufficient grounds for immediate discharge, if I am employed. By entering my initials and submitting this form, I acknowledge that I have read and agree to the above statement.

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