Gwinnett Clinic Application – Phase I

Name*

First Last

Resume*

Drop files here or

Max. file size: 50 MB, Max. files: 3.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

How did you hear about us?*

What position you are applying for?*

Patient Care Representative
Medical Assistant / Nurse
Other

Please choose all that apply.

If other, please note here:

Office Skills

Please choose all that apply.

Typing
Medical Terminology
Insurance Verification
Collection of Money
Posting on Money
Appointment Scheduling
Customer Service
Patient Registration
Filing / Medical Records

What is your typing speed?*

If you are unsure, please go to www.typingtest.com/ScoreTrim/ on a desktop or laptop to find out your WPM (words per minute).

Technical Skills / Lab Work

Please check all that apply.

Triage
Urinalysis
EKG
Injections
Venipuncture
EMR
Supply Management
Patient Calls for Results

If you selected "Injections" above, please specify the name(s) of the injection(s) you've done:

Other Relevant Skills

Bone Density
X-Ray
Other

If other, please note here:

Are you looking for a full-time or part-time position?*

Full-time: 30-40 hrs / week, you will be required to work 4 weekend days out of every 4 weeks, generally 2 Saturdays and 2 Sundays Part-time: 24 hrs or less, no weekend requirement

Full-time
Part-time
Either

Please indicate the hours you are available to work.*

Select all that apply. Please keep in mind: ** Full-time: 30-40 hrs / week, you will be required to work 4 weekend days out of every 4 weeks, generally 2 Saturdays and 2 Sundays. ** Part-time: 24 hrs or less, no weekend requirement.

Are you currently working?*

Yes
No

Why are you looking for a new position?*

Can you tell us about some of your daily tasks and responsibilities at your current position?*

Why did you leave your previous position?*

Can you tell us about some of your daily tasks and responsibilities at your last position?*

Please explain below if you have changed jobs more than once a year.

Where do you see yourself in 5 years? (100 words or less)*

What is your motivation for working in health care?*

When would be your potential start date?*

How many miles are you comfortable traveling?*

We have 19 locations in and around Gwinnett County. See them here: www.gwinnettclinic.com/our-locations/

What is your salary expectation per hour?*

Please give a range.

Our payroll is every 4 weeks, meaning you will be paid every 28 days.*

Please initial for acknowledgement.

Please review our mission, values, and core principles using the link below. Why would you be a good fit?*

www.gwinnettclinic.com/about/our-mission/

Anything else you would like us to know? Example: relocating, availability (if you are in school), etc.

I certify that the information submitted in this application is true and correct to the best of my knowledge. I further understand that any false statements may result in denial or future termination of the position. Please e-sign below.*

Phone

This field is for validation purposes and should be left unchanged.

Appointments

Gwinnett Clinic Application - Phase I

Braselton

Dacula

Duluth / Breckinridge

Duluth / Pleasant Hill

Johns Creek

Lawrenceville / Main

Lilburn

Loganville

Monroe

Patterson

Peachtree Corners

Snellville

Sugar Hill / Buford

Suwanee

Tucker

Webb Gin

Winder