Welcome :: Sturbridge :: Online Interview Form

Hello and thanks for being here! My name is Steve and my job is to take care of the business side of our office so that doctors can concentrate on patient care. Your information will be sent to our office manager for review and further processing. Please understand we get many applications and some people are more qualified for the job than others. If necessary, she will contact you for an in-person interview. THANK YOU!

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Online Interview Form * indicates a required field

Position You Are Applying For:

*Full Name:

*Date:

*Address:

*City:

*State:

*Zip:

*Phone (day):

Phone (Other):

*E-MAIL ADDRESS:

Sex:

Marital Status (optional):

Date of Birth (optional):

Age (optional):

Spouse's Name (optional):

Children's ages (optional):

About You

HIgh School Diploma or GED?:

Highest Level of Education Completed

Describe yourself:

*Why would you do well at this position?*

*What are you doing now?

*Have you ever been under chiropractic care?

When would you be ready to start?

What attributes can you contribute to the office?

Prior Work Experience

Most Recent Employer :

Position:

Dates Worked:

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Wage/Salary Earned:

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Employer 2:

Position:

Dates Worked:

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Wage/Salary Earned:

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Employer 3:

Position:

Dates Worked:

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Wage/Salary Earned:

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Employer 4:

Position:

Dates Worked:

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Wage/Salary Earned:

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Special Skills:

How Did You Hear About Our Opportunity?

Anything Else You want To Add?

Click The Browse Button To Attach a Resume or Photograph (Optional)

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This form will be emailed to our clinic when you press submit. I understand that internet email is not secure or encrypted.

	We focus on the patient and the patient's condition.
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