Employment Application Form
Please complete the following form.

First Name
    Last Name

Home Address

Home Address 2

City
 State

Zip Code

Home Phone
    Work Phone
E-mail Address

What is the best time to reach you?
What position are you applying for?

Are you a citizen of the United States or do you have
a legal right to be employed in the United States?
  

What employment status are you applying for?

If you are not applying for a position as a Medical Language Specialist please skip to Paste Resume

How many hours a week would you like to work?
   

When would you be available to start?

Do you have a formal education in transcription?

If Yes, list completed program here:

If No, did you learn on the job?

Where?

What is your current/most recent transcription
employer and dates of employment?

How many working years of acute-care/
hospital experience do you have?

How many working years of multi-specialty
clinic experience do you have?

Do you have experience transcribing for foreign dictators?

What software have you previously used
for medical transcription?

Are you familiar with any type of word expansion software?

How well do you work independently?

Work Type Experience (check all that apply)

List and describe any professional organizations, specialized
training or other involvement relating to transcription:

Paste Resume (optional)