Mammography Tech - Part Time - Wolf River

First Name, Last Name, Email, Phone, Resume/CV, Cover Letter, Location

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• Interested in Working, Full-time, Part-time, Supplemental optional
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• If referred, please list name of the associate that referred you optional
• What are your salary expectations?
• List active, relevant certifications and expiration dates written answer · optional
• List active, relevant licensure, expiration dates and state if applicable written answer · optional
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• Have you ever worked for West Clinic/West Cancer Center or its affiliates in the past? choose one
• If you have worked for West Clinic/West Cancer Center or its affiliates in the past, please list positions(s) and any other name or alias used while employed. optional
• Do you have any relatives or household members employed by West Cancer Center? If so, please indicate name, job title, and location. Do not include any information or identification of marital status. written answer
• Have you ever been terminated or resigned in lieu of termination? choose one
• If you have ever been terminated or resigned in lieu of termination , please explain: written answer · optional
• Are you legally authorized to work in the United States? choose one
• How many years’ experience do you have for this position?
• May we contact your current employer? choose one
• Have you ever been convicted, pled no contest, or pled guilty to a felony or do you currently have a pending charge? Type YES or NO. If yes, please explain: written answer
• Have you ever been convicted, pled no contest, or pled guilty to ANY misdemeanor to include involving fraud, writing bad checks, theft, DUI, or drugs? DO NOT include juvenile cases or cases sealed or expunged by a court. Do not assume charges have been removed. Type YES or NO. If yes, please explain: written answer
• Have you currently or have you previously been excluded, suspended, or otherwise been ineligible for participation in federal programs, or do you have a controlling interest in an entity that has been so excluded or suspended? Have you ever been sanctioned, disciplined, debarred, and/or excluded by a duly authorized regulatory agency, or are there current restrictions/limits on your license or certification? Type YES or NO. If yes, please explain: written answer
• Have you ever served as an expert witness or consultant in healthcare malpractice cases? Type YES or NO. If yes, please explain: written answer
• Are you presently under an employment contract? choose one
• If you are presently under an employment contract, when does it expire? optional
• Please provide 5 professional references to include their name, phone, number, and email address. written answer
• Please list any other names used (maiden, alias, nickname) or type NONE. written answer
• I understand that West Clinic/West Cancer Center does not respond to application status inquires until I have been selected for a position or the position is filled by another candidate? choose any
• I hereby authorize West Clinic/West Cancer Center to conduct work history, education, personal reference, or police record inquires to determine my acceptability for employment. I authorize West Clinic/West Cancer Center and its agents to procure a consume report and/or investigate consumer report about my background, character or reputation, including, but not limited to information as to my employment, education, consumer credit history (if appropriate for certain job descriptions), driving record, social security number verification, criminal record, and/or public record history. I authorize all persons to fully disclose information relevant to this investigation. I release from liability all persons, companies, and government or other agencies disclosing such information. I further authorize that a photocopy of this authorization may be considered an original. choose any
• I understand that by submitting this application, I acknowledge and warrant the truthfulness of the information provided in this document. choose any