Employment Application

EMPLOYMENT HISTORY

EDUCATION

High School

COLLEGE

Other Education

SKILLS

OTHER EMPLOYMENT QUESTIONS

Note: No applicant will be denied employment solely on the grounds of conviction for a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event and the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered.

REFERENCES

Please provide the name, employer and contact information of three persons not related to you with whom you have worked for or with in the past 5 years.

APPLICANT ATTESTATION

By submitting this application I verify that all the information which I have provided on this application and in related materials is true, correct, and complete. I understand that any false, misleading, incomplete, or omitted information will result in rejection of my application, withdrawal of a job offer, or dismissal from employment, whenever discovered. I authorize such information to be used for any decisions relating to my hiring and continued employment. I release any and all persons or companies from any liability or damages for obtaining or releasing information or verifying statements provided by me.

I understand that if I am hired by Family Physicians of Greeley, PLLP I must complete a Federal I-9 form and provide verifying documentation of my legal right to reside and work in the United States prior to beginning employment.

All candidates who receive an offer of employment will be required to undergo testing for commonly-abused controlled substances. Successful completion of drug screening is a requirement for employment at Family Physicians of Greeley, PLLP. All candidates who receive an offer of employment are subject to a background investigation for social security number verification and criminal history.

I agree, if employed, to abide by all Family Physicians of Greeley, PLLP rules and regulations. I understand that such employment is for an indefinite period of time and that Family Physicians of Greeley, PLLP can change wages, benefits and conditions of employment at any time.

Family Physicians of Greeley, PLLP is an equal opportunity employer. Qualified applicants will be considered for openings without regard to race, color, religion, sex, age, national origin, veteran status, or disability. Information on this application will not be used to discriminate against any applicant.

All offices of Family Physicians of Greeley are non-smoking environments.
Please type your legal name as your E-Signature for this Application of Employment

UPLOAD DOCUMENTS

Upload documents such as a resume, cover letter or reference letters

CONTACT US

New Patient Inquiry / Non-Medical Questions

contact

* All indicated fields must be completed.
Please include non-medical questions and correspondence only.

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OFFICE HOURS

Call us 24 hours a day, 7 days a week.
Mon – Fri: 7:30am - 5pm
Sat: 8am - 12pm
Sat Lab & X-Ray hours: 8am - 12pm (West office only)

Our Locations

(970) 356-6928

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(970) 353-2801

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more Locations

(970) 587-7738

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(970) 378-8088

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