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Basic Information for Employment
First Name
Middle Initial
Last Name
Licensed Position
Present Address
City
State
Zip
Cell Phone
Home Phone
Email Address
Have you ever worked at Test-med?
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Yes
No
Date you can start work
Are you presently employed?
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Yes
No
Please specify which days you would be available to work by checking the boxes below
Corporate Schedules
Must be available all day
Most corporate scheduled are 8-4pm or 9-5pm
T
uesday
W
ednesday
T
hursday
F
riday
Public Clinic Schedules
All clinics are 4 to 5 hour shifts
Most clinics operate 9:30 - 2:30pm
W
ednesday
T
hursday
F
riday
S
aturday
S
unday
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