Tell us about you
Please complete as many fields as possible. Fields in red are required.
Day/Hours Availability
Please enter the hours you are available on the following days
How did you hear about us?
Required
If you were referred by a current employee, what is their name?
Do you have a high school diploma or equivalent?
Required
Have you ever applied to FHC before?
Required
If yes, please give a date
Have you ever worked for FHC before?
Required
If yes, please give a date
Do you have a valid driver's license? (For driving positions only.)
Is anyone related to you employed by FHC?
Required
If Yes, please list name and relationship to you.
What salary or rate of pay do you expect to receive if employed?
Required
Have you ever been fired or asked to resign from a job?
Required
If yes, please explain
Are you currently employed?
Required
May we contact your present employer for references?
Required
If you were referred by a current employee, what is their name?
If Yes, name and phone number
Describe any specialized training, apprenticeships, or skills.
Please indicate your level of experience with Microsoft Office.
Required
Please indicate your level of experience with Microsoft Word.
Required
Please indicate your level of experience with Microsoft Excel.
Required
Please indicate your level of experience with Microsoft Outlook.
Required
Please indicate your level of experience with Microsoft PowerPoint.
Required
Please indicate your level of experience with Microsoft Access.
Required
Please indicate your level of experience with Electronic Health Records (EHR).
Required
Please list the names of Electronic Health Records (EHR) software you have used.
Required
Please indicate your level of experience with Practice Management System.
Required
Please list the names of Practice Management Systems software you have used.
Required
Type of professional License(s) or Membership(s) held?
License(s) or Membership(s) expiration Date(s)
State and License Number
Please list any academic honors, scholarships, offices held, professional, trade, business or civic activities, etc. applicable to the position. (Do not list any which reflect your race, color, religion, gender, national origin, age, disabilities, or veteran status.)
Can you perform the essential functions of the job, with or without reasonable accommodation? (If you have any questions about the functions of the job, please ask the interviewer before answering this question.)
Required
Have you ever worked for FHC before?
Required
If yes, please give a date
What salary or rate of pay do you expect to receive if employed?
Required