We are currently taking applications for a new team member to serve on our staff. Interested applicants should complete the electronic application below. Qualified candidates will be contacted for an interview. Employment Application Step 1 of 5 20% Contact InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Date of Birth* MM slash DD slash YYYY Are you a US Citizen?* Yes No Have you ever been covicted of a felony?* Yes No Please Explain:* Education and SkillsWhere did you attend high school?* Did you graduate from high school or get your GED?* Graduated from high school Received my GED Neither What year did you graduate from high school or receive your GED?* A1. Have you been to college?* Yes No A2. Where did you go to college?* A3. What was your major?* A4. Did you complete your college degree?* Yes No A5. Approximate dates in college:* A6. What year did you complete your degree?* B1. Do you have any additional college experience?* Yes No B2. Where else did you go to college?* B3. What was your major?* B4. Did you complete your college degree?* Yes No B5. Approximate dates in college:* B6. What year did you complete your degree?* C1. Do you have any additional college experience?* Yes No C2. Where else did you go to college?* C3. What was your major?* C4. Approximate dates in college:* C5. Did you complete your college degree?* Yes No C6. What year did you complete your degree?* Are you currently in school?* Yes No Please explain your current class schedule:*Date you are available to begin work?* MM slash DD slash YYYY What type of position are you interested in?* Part-Time prn (as needed) Full Time Only I am interested in any position Minimum number of hours you would consider working on a weekly basis?* Do you have prior experience with performing any of the following?*Phlebotomy/VenipunctureDrug Screen CollectionDNA Specimen CollectionQuickbooksBreath Alcohol TestingNone(hold control to select multiple options)Please list any relevant certifications you hold. Employment HistoryA1. Prior Employer: A2. Title: A3. Start Date: MM slash DD slash YYYY A4. End Date: MM slash DD slash YYYY A5. Job Responsibilities:A6. Why did you leave this position?B. Do you have additional relevant employment history? Yes No B1. Prior Employer: B2. Title: B3. Start Date: MM slash DD slash YYYY B4. End Date: MM slash DD slash YYYY B5. Job Responsibilites:B6. Why did you leave this position?C1. Do have any other relevant employment history? Yes No C2. Prior Employer: C3. Title: C4. Start Date: MM slash DD slash YYYY C5. End Date: MM slash DD slash YYYY C6. Job Responsibilites:C6. Why did you leave this position?Please explain any lapse in employment history. ReferencesA1. Name First Last A2. PhoneA3. How do you know this reference? B1. Name First Last B2. PhoneB3. How do you know this reference? C1. Name First Last C2. PhoneC3. How do you know this reference? What is your greatest strength?*What is your greatest weakness?*Describe Yourself*What would your ideal position at our facility be.*What is your greatest accomplishment thus far in life?*Any other pertinent information you would like us to know.If you would like to send us a Resume, you may email it to Info@MedScreensInc.com.
