Neurology Physician

Summary Title: Title: Neurology Physician ID:

ID: 1492

Location: Department: Department: Clinics- Hospital Status: Status: Full Time Shift: Shift: N/A Resume Resume: Supported formats: Word, PDF, RTF, Text, and HTML. - or Upload from: Contact Information * First Name: * Last Name: * Address 1: Address 2: * City: * State: * Phone: * Email: Opt-In Confirmation By submitting this application, I consent to receive SMS updates from Nevada Regional Medical Center at View phone number on click.appcast.io regarding my employment application. My information will not be shared or used for any other purposes. This application is powered by ApplicantStack on behalf of Nevada Regional Medical Center. SMS messages will only be sent by Nevada Regional Medical Center and are used exclusively for hiring-related communications when you have subscribed to receive SMS communications. Attachments You can type in a Cover Letter or Copy/Paste from an existing document. NRMC Health - Custom Application for Employment

PERSONAL INFORMATION

• Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment) Yes No
• Will you now or in the future require employer sponsorship to work in the United States? Yes No
• Are you at least 18 years or older? (If no, you may be required to provide authorization to work) Yes No
• Have you ever worked for this Company before? Yes No

If Yes, please provide details (Where/When/Job Title) How did you hear about us? * Were you referred by a current employee? Yes No If yes, please provide name. * Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? Yes No If no, please explain

• Have you ever worked for Nevada Regional Medical Center, Moore Few Care Center or Barone Alzheimer’s Care Center? Yes No
• Are you related to any current employees? Yes No

If yes, please explain. * Have you ever been convicted of a crime? Yes No If yes, please explain.

EMPLOYMENT DESIRED

When would you be available to begin work? Type of employment desired Full Time Part Time Seasonal Hourly rate/salary desired Are you currently employed? Yes No If so may we inquire of your present employer? Yes No If presently employed, why are you considering leaving?

EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended. School 1 Name Location Did you Graduate? Yes No Degree Received Subjects Studied/Major School 2 Name Location Did you Graduate? Yes No Degree Received Subjects Studied/Major School 3 Name Location Did you Graduate? Yes No Degree Received Subjects Studied/Major School 4 Name Location Did you Graduate? Yes No Degree Received Subjects Studied/Major School 5 Name Location Did you Graduate? Yes No Degree Received Subjects Studied/Major

SKILLS

License or Certification Number State issued License or Certification Number State issued License or Certification Number State issued Do you have a Current/Valid Driver’s License Yes No Do you have Proof of insurance Yes No

EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment. Employer 1 Job Title * From * To * Company Name * Company Address * Company Phone *

May we Contact? * Yes No Responsibilities * Reason for Leaving * Employer 2 Job Title From To Company Name Company Address Company Phone May we Contact? Yes No Responsibilities Reason for Leaving Employer 3 Job Title From To Company Name Company Address Company Phone May we Contact? Yes No Responsibilities Reason for Leaving Employer 4 Job Title From #J-18808-Ljbffr Nevada Regional Medical Center