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Career Application
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Name
*
First
Last
Prior Name
Email
*
Phone
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Date Available for Employment
Month
Day
Year
Desired Salary
*
Computer Skills
List applications you have experience with
Other Job Related Skills
Position applying for:
*
-- select a Post --
Advanced Practice Practitioner
Full-Time Coding Specialist
Part-Time Clinical Surgery Scheduler
Neurologist
Full-Time Certified Athletic Trainer
Full-Time Authorization Specialist
Full-Time Medical Records Clerk
Full-Time Front Desk Ambassador
Flex X-Ray Technician
Full-Time X-Ray Technologist
Full-Time Clinical Assistant
Full-Time RN or CMA
Full-Time LPN or CMA
Are you applying for
*
Full Time
Part Time
Flex Tim
Temporary
How were you referred to CNOS?
Have you ever been employed by CNOS?
*
Yes
No
Position
Department
Start Date
Month
Day
Year
End Date
Month
Day
Year
Are you willing to provide necessary documentation to establish your identity and your authorization to work in the United States under Immigration Reform and Control Act of 1986?
*
Yes
No
After reviewing the essential functions of the job for which you are applying, are you able to perform these essential functions with or without an accommodation?
*
Yes
No
If you can perform the functions with an accommodation(s), please explain how you would perform the functions and with what accommodation(s)
Do you have any commitments to another employer that might affect your employment with us? Please explain
*
Since reaching age 18, have you ever been convicted of a misdemeanor or felony? (Note: Convictions will not necessarily bar you from employment but are reviewed as related to the relevancy of the job for which you have applied)
*
Yes
No
Please Explain
Year
County
Previous Employment
Previous Employer
*
Position
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Reason For Leaving
Duration
Salary
Please list your previous employers
*
List the most recent first.
Previous Employer
Position
City/State
Reason For Leaving
Duration
Salary
Add
Remove
Has notice been given to present employer?
Yes
No
May we run an employment check from the employers listed above?
*
Yes
No
Have You Served in the Military?
*
Yes
No
From
Month
Day
Year
To
Month
Day
Year
Highest Rank Obtained
Branch of Service
Additional Information
List any other country, state and city in which you have lived during the past 7 years.
List
City and State
Country
Year
Add
Remove
Please include any information you think would be helpful to use in considering you for employment, such as additional work experience, publication, activities, accomplishments, etc.
You may exclude all information indicative of age, sex, religion, color
References
List
*
Name
Title/Occupation
Company/Address
Phone Number
Add
Remove
Education
HS/College/University
*
School Name and Address
Course of Study
Degree or Diploma
Last Year Completed
Add
Remove
Did You Graduate?
Yes
No
Professional License / Certificate
Professional License / Certificate
Type
State
Expiration Date
Registration Number
Add
Remove
Resume / Cover Letter
Resume / Cover Letter
If you have a resume or cover letter prepared, you may upload it here.
Drop files here or
Select files
Accepted file types: doc, docx, pdf, png, jpg, Max. file size: 256 MB, Max. files: 2.
Consent
Agreement
*
I hereby affirm that the information provided on this application, (and accompanying resume, if any), is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself. I understand that no management official of the employer, other than the Chief Executive Officer of the employer, has any authority to enter into any agreement contrary to the foregoing or to make any oral assurance or promise of continued employment to me. I authorize person, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any), to provide any relevant information that may be required to arrive at an employment decision.
I agree
Please Read Carefully Before Signing This Application
I authorize the Company to investigate all statements in this application and to secure any necessary information from all my employers and references. I hereby release all of those employers and references, and the Company from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the Company. I also authorize the Company to secure financial,credit and background information through an appropriate agency. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my credit, academic credentials, employment references and drug screen. I further understand that any false or misleading statements will be sufficient cause for rejection of my application if the Company has not employed me and for immediate dismissal if the Company has employed me. I also authorize the Company to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest, and I hereby release the Company from any and all liability for its providing this information. In the event of my employment with the Company, I will comply with all rules, regulations, and policies set forth in the Company's policy manual or other communications distributed by the Company. I understand that nothing in this employment application, in the Company's policy statements or personnel guidelines or in my communications with any Company official is intended to create an employment contract between the Company and me. I also understand that the Company has the right to modify its policies without giving me any notice of the changes. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless it is made in writing and signed by a Company officer. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. I also understand that the Company retains the right to terminate my employment at any time for any reason. I hereby acknowledge that I have read and understand the preceding statement.
Fair Credit Reporting Act Consumer Report Disclosure
As required by the Fair Credit Reporting Act, this is to advise you that, in connection with your application for employment with CNOS, PC, a consumer report regarding your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, may be obtained with respect to you for employment purposes for a consumer reporting agency. I hereby authorize CNOS, PC, to obtain and use a consumer report with respect to me for employment purposes.
Signature
*
Date
*
Month
Day
Year