TULSA’S TOP DOCTORS + STATE OF THE ART FACILITIES = THE BEST SURGICAL CARE IN THE AREA First Name Last Name E-mail:* Date: MM slash DD slash YYYY Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Social Security Number* Work PhoneAre you over the age of 18? Yes No Able to perform job duties? Yes No Authorized to work in U.S.? Yes No Are you a convicted felon? Yes No How did you hear about this position? Have you ever employed with us before? Yes No List any relatives currently employed with us Employment Desired (FT or PT): Numbers of hours per week Location &/or Position applied for Days of the week willing to work Sunday Monday Tuesday Wednesday Thursday Friday Saturday High School Name and Location High School Degree College Name and Location College Major Latest Employer Start Date: MM slash DD slash YYYY Latest Employer End Date: MM slash DD slash YYYY Latest Employer Name Latest Employer TelephoneLatest Employer Street Address Latest Employer City Latest Employer State Latest Employer Zip Latest Employer Job Title Latest Employer Immediate Supervisor Latest Employer Hourly Rate/Salary Latest Employer Job Duties Latest Employer Reason for Leaving Previous Employer Start Date: MM slash DD slash YYYY Previous Employer End Date: MM slash DD slash YYYY Previous Employer Name: Previous Employer City Previous Employer State Previous Employer Zip Previous Employer Job Title Previous Employer Immediate Supervisor Previous Employer Hourly Rate/Salary Previous Employer Job Duties Previous Employer Reason for Leaving Previous Employer Reason for Leaving Agree to Terms* I agree to the authorization terms as listed above In addition to work history, are there other skills, qualifications, or experience that we should consider?Digital Signature Reference 1 Name Reference 1 Address Reference 1 Phone Number Reference 1 Years Known Reference 2 Name Reference 2 Address Reference 2 Phone Number Reference 2 Years Known Campus BRISTOW MEDICAL CENTER 700 W. 7th Ave Bristow, OK 74010 918-367-2215 Location and Directions CORE 3029 W. Main Street Jenks, OK 74037 918-701-2300 Location and DirectionsAbout Your >> SURGERY >> APPOINTMENT >> HOSPITAL STAY >> PAY YOUR BILL OUTSTANDING PATIENT ROOMS 24-HOUR EMERGENCY ROOM INVITING DESIGN PATIENT-FOCUSED RECOVERY
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