25Health and Safety_doctorteam02_l_000000_FFFFFF.jpg

AFC Urgent Care Florham Park, NJ

Please fill in all required (*) fields below, and attach your CV at the end of the form.

General Info

First Name *

Last Name *

Street Address - Line 1 *

Street Address - Line 2

City *

State *

Zip Code *

Tel# as (111) 222-3333 *

Email Address *

Please re-enter email *

Where did you see this job posted? (please be specific) *

Technical Qualifications

Where did you attend RT school? *

Year graduated from RT school? *

Are you authorized to work in the U.S.? *

Yes

No

Are you currently licensed in NJ? *

Yes

No

If not, when do you expect to receive your license? +

What type of engagement are you seeking? *

Part-time only	Full-time only	Per diem
Flexible

Assuming there exists a match, how soon are you available to start? * +

Personal Background

Have you ever been terminated from employment or contract work? *

Yes

No

Have you ever been convicted of a crime? *

Yes

No

Have you ever been involved in substance abuse? *

Yes

No

Please note that we require all medical staff to undergo pre-employment drug screening, have all credentials, licenses and certifications verified, and backgrounds checked for criminal violations. Do you object to providing your consent for any of the above tests, checks and verifications? *

Yes

No

Comfort Zone

Do you enjoy working the front desk? *

Yes

Somewhat

No

Are you good at thinking on your feet? *

Yes

Somewhat

No

Do you enjoy paying attention to fine details? *

Yes

Somewhat

No

How do you feel when under pressure? *

Energized

Seek Help

Lost

What do you enjoy most outside of work (1-5 words)? *

Final Step: Submit CV / Resume

CV / Resume (PDF or Word files, max. size 512KB) *

<< PLEASE UPLOAD YOUR CV/RESUME

<< BEFORE YOU CLICK SUBMIT BELOW.