Functional Medicine Practitioner (MD/DO or NP) Contractor

Resume/CV, Full name, Pronouns, Email, Phone, Current location, Current company, LinkedIn URL, Twitter URL, GitHub URL, Portfolio URL, Other website, Age, Race/EthnicitySelect all that apply, Gender, Transgender, Sexual Orientation, Disability (as outlined by the ADA), Veteran/Military Service, Pronoun(s)

• Do any of your immediate family members have an employment, consulting, or other financial relationship with Everly Health or any of its subsidiaries? choose one
• Are you authorized to work in the US? choose one
• Will you now or in the future require a sponsorship? choose one
• Do you currently work at or have you ever worked at Everly Health? choose one
• Did a current Everly Health employee refer you to the role? choose one
• If yes, please name the employee that referred you written answer · optional
• Do you have any employment, consulting, occupation, or board-service obligations that would interfere with your ability to work full-time for Everly Health or that would conflict with the business, goals, or mission of Everly Health? choose one
• If yes, please briefly describe those obligations written answer · optional
• Have you ever worked for a State agency and been involved, in any capacity, in the process of procurement of goods or services, selection of vendors, or contract management? choose one
• If yes, please describe written answer · optional
• Do you have any limitations that may prevent you from performing the essential functions of this position? choose one
• If yes, please explain: written answer · optional
• Do you currently use any illegal drugs? choose one
• Have you ever experienced a loss of professional license or been convicted of a felony? choose one
• Do you have any history of loss or limitation of professional privileges or disciplinary actions? choose one
• If yes, please explain: written answer · optional
• Do you currently hold malpractice insurance coverage? choose one