Employment:

Before continuing, please note:

The experience requirements must be actual on the job experiences.
All candidates must possess a minimum of six month's transcription experience.
This is an important tool in evaluating and matching your abilities to our current needs. Upon successful completion of this process, applicants that meet our requirements and current account needs will be contacted to discuss employment opportunities. All other applications will be kept on file for future consideration. Applicants will be considered for employment only if they have transcription experience in one or more of the following areas:

Acute Care Facilities
Physician Office Environment

Personal Data

Name Social Security No
Permanent Address How Long

Telephone Numbers Cell
E-mail Address
Previous Address How Long

Position Applied For
Rate of Pay /line How Did You Hear of Us?
Full Time Part Time Hours You Can Work Mon-Fri Sat/Sun

Have you worked with us before? No Yes
If yes, explain, listing previous job/title/location and length of service.

What was your reason for leaving?

List any friends and/or relatives working with us now.
Do you speak any foreign languages fluently? No Yes
Please List
Are you over 21? No Yes (If no, hire is subject to minimal legal age verification.)
Sex: Male Female
Have you ever been bonded? No Yes When
Have you been convicted of a crime in the past 10 years (including traffic violations)?:
No Yes - Explain

Education/Qualifications

Name and location of school Graduated no yes
Major

Employment History

List in reverse order beginning with
Present Employer:
Company Name
Address
Contact and Phone No.
Job/Title Start Date End Date Salary
Reason for Leaving

Previous Employers
Company Name
Address
Contact and Phone No.
Job/Title Start Date End Date Salary
Reason for Leaving

Company Name
Address
Contact and Phone No.
Job/Title Start Date End Date Salary
Reason for Leaving

Company Name
Address
Contact and Phone No.
Job/Title Start Date End Date Salary
Reason for Leaving

References
May we contact the employers listed above as a reference? No

Military Service

List any special schools or skills acquired in the service:

I am interested in a hospital, ER, or radiology medical transcriptionist position:
I am interested in a multi-specialty clinic medical transcriptionist position:
I received a medical transcription certificate in the past 12 months from a medical transcriptionist school or college:
School Name
Address
Phone No.

The applicant gives the employer the right to obtain credit information, public records, criminal records and verify references.