Employment Application

Application for Employment

Pediatric Interactions Inc. is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

Full Name*

Email*

Address*

Phone*

How did you hear about Pediatric Interactions?*

Position Applied for*

Salary Hourly Compensation Desired*

Are you at least 18 years old?*

Yes

No

Do you have any relatives employed by Pediatric Interactions Inc. or it's affiliates?*

If yes, list Names:

May we contact your current employer for references?*

If hired, will you be able to work overtime?*

Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?*

Take the Big 5 Personality Traits (OCEAN) and indicate your results (available at: https://www.scienceofpeople.com/personality/)*

Additional Comments/Questions

Do you have a resume on file with Pediatric Interactions?*

Indicate Level of Education Completed*

Name and Location of Last Educational Institution Attended*

Major Area of Studies at Last Educational Institution Attended*

Please describe your computer skills experience*

Employer Name and Address*

Employed From*

Employed To*

Job Title*

Duties and Responsibilities*

Supervisors Name*

Supervisors Phone*

Starting Compensation*

Ending Compensation*

Reason for Leaving*

Additional Employers and Above Requested Information*

*I hereby acknowledge that I have read and agree to the above statements.

ADDRESS & CONTACT

OFFICE HOURS

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