Job Application Form
01
Basic Info
02
Employment History
03
References
04
Additional Info
05
Sign & Submit
Basic Information:
Applicant's Name:
Select title
Ms
Miss
Mrs
Mr
Primary Phone:
Mobile Phone:
Applicant's Email:
What position are you applying for?
Position on Website
Office Position
Clinic/Ortho Fitter
Information Technology
Sales
Executive
Lab Tech
If this is an opening posted on our website OR an internal opening please specify:
Enter Job Title/Description
Available start date
Salary or Wage?
Salary
Hourly Wage
Expected Salary/Wage
What is your current employment status?
Employed
Self-Employed
Unemployed
Student
Attach Resume (optional)
Please attach only MS Word documents
Uploading, please wait...
Upload
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Employment History:
Employer #1 (Most Recent)
Job Title:
Manager's Name:
Phone:
Start Date:
End Date:
Reason for Leaving:
Employer #2:
Job Title:
Manager's Name:
Phone:
Start Date:
End Date:
Reason for Leaving:
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References:
Reference #1:
Email:
Phone:
Relation to Applicant:
Co-worker
Family
Friend
Spouse
Pastor
Other
Reference #2:
Email:
Phone:
Relation to Applicant:
Co-worker
Family
Friend
Spouse
Pastor
Other
Reference #3:
Email:
Phone:
Relation to Applicant:
Co-worker
Family
Friend
Spouse
Pastor
Other
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Additional Information:
Education:
High School Name:
Graduate?
Yes
No
College:
Graduate?
Yes
No
Degree(s) Received:
Other or Ongoing Education:
Gender
Male
Female
Other:
Date of Birth
Are you a U.S. citizen or eligible to work in the U.S.?
Yes
No
Have you ever been convicted of a felony?
Yes
No
Do you have a valid driver's license?
Yes
No
Revoked
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Sign and Submit:
All of the information entered is completely accurate to the best of my knowledge
I Agree
Digital signature:
Use mouse or stylus to sign
Clear
Date of Submission:
Your submission will be sent to our main office. You can also fax a copy to ATTN: Katie Weaver @ (864) 457-2269
Submit the Online Job Application Form
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