Knoxville TN Chiropractic Team Member Application

Name: Scoles Family Chiropractic: Scoles Jennifer DC
Address: 7555 Oak Ridge Highway, Knoxville, Tennessee, 37931, United States
Telephone: 18655318025
Price range: $

Application for Employment

Welcome
Thank you for your interest in our position. Please fill out the application below and it will submit securely to our office. We look forward to hearing from you.
Name
First Last
Date
MM slash DD slash YYYY
Email
Home Phone
Cell Phone
Address
Street Address Address Line 2 City State ZIP Code
How did you hear about the position?
If hired, would you have transportation to/from work?
Are you over the age of 18?
If hired, would you be able to present evidence of your USA citizenship or proof of your legal right to work in USA?
Do you have any past experience in the chiropractic, medical, or dental field?
If so, please describe
Past Employment
List in chronological order beginning with the most recent, if already included in your resume, please complete the details below anyway.
Name of company
Dates worked
City/State
Supervisor
May we contact?
Phone
Wage Received?
Reason for leaving?
What were your duties?
What did you like most?
What did you like least?
Second most recent position.
Name of company
Dates worked
City/State
Supervisor
May we contact?
Phone
Wage Received?
Reason for leaving?
What were your duties?
What did you like most?
What did you like least?
References
List below three persons who have knowledge of your work performance within the last four years. Please include a minimum of 2 professional references.
BUSINESS REFERENCES
Name
Phone
Occupation
Number of Years Acquainted
Name
Phone
Occupation
Number of Years Acquainted
PERSONAL REFERENCES
Name
Phone
Relationship
Number of Years Acquainted
Education
List in chronological order beginning with the most recent, if included in resume, please be sure to include GPA.
School
Dates Attended
Degree Obtained
GPA
School
Dates Attended
Degree Obtained
GPA
Personal Information
Where do you see yourself five years from now?
Do you like to work with
- Figures
- Computers
- People
Are you applying for
- Regular part-time work (25-34hrs/wk)
- Regular full-time work (35-40 hrs/wk)
What days and hours are you available for work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you have any hour limitations for working?
If so, what?
If hired, on what date can you start working?
MM slash DD slash YYYY
Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation?
If no, describe the functions that cannot be performed
Career Aims/Personality Assessment
What qualifications, abilities and strong points will help you to succeed in this position?
What is the starting hourly compensation are you seeking for this position?
Do you speak, write or understand any foreign languages?
If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be.
Please describe the type of work you enjoy doing
What would be your ideal career?
What is your experience with chiropractic?
What are you truly passionate about?
List your six best assets
Please rate yourself on a scale of 1-10, 10 being the highest (you can use the same number multiple times)
Willingness
Flexibility
Responsibility
Office Skills
Self-Esteem
Dependability
Assertiveness
Enthusiasm
Multi-tasking
Attention to details
Competitive
Confrontation Skills
Do you have self confidence?
How do you see yourself?
What is YOUR definition of health?
Please Read and Sign below.
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.