Application Form Name * First Name Last Name Phone * Country (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Position Applied For * Registered Nurse Medical Assistant Clinical Research Coordinator Patient Service Representative Availability * Desired Start Date MM DD YYYY Work Availability * Full-time Part-time Are you legally eligible to work in the United States? * Yes No Education * Bachelor’s Degree Associate’s Degree High School Other Licenses/Certifications * Type of License/Certification (e.g., RN, Medical Assistant Certification) Work Experience * Company Name Position Held Dates of Employment (Start Date - End Date) Key Responsibilities (Short text field) Why are you interested in working at Palm Springs Community Health Center? * I consent to Palm Springs Community Health Center contacting my references and conducting background checks as part of the hiring process. * Yes No Thank you!
