Georgia Urgent Care Employment Application

Please complete the application below. Field with an * are required.
If you are contacted for an interview, plan on bringing a hard copy of your resume with you.

Georgia Urgent Care does not discriminate against applicants on the basis of race, sex, color, religion, sexual orientation,
national origin, age, disability, or veteran status.  We are an Equal Employment Opportunity Employer.

First Name
*
Last Name
*
Middle Initial
*
Home Phone
*
Mobile Phone
Address
*
City
*
State
*
Zip
*
Email Address
*
Previous Residence
Previous City
Previous State
Previous Zip
Position Applying For
*
Days Available
*
Salary Desired
*
How did youhear about the position?
Have you ever worked here or for an affiliated practice before?
* Yes
No
When?
Why did you leave?
Have you ever served in the military?
* Yes
No
Branch Served?
Dates Served?
Are you currently in the reserves?
Yes
No
Name of High School
Major Area Studied in High School
Years Complete-Degree in High School
Name of VoTech School
Major Area Studied in VoTech School
Years Completed-Degree in VoTech School
Name of College
Major Area Studied in College
Years Completed-Degree in College
Name of Post College
Major Area Studied Post College
Years Completed-Degree Post College
Last Company Name
Last Company Address
Last Position
Last Company Dates
Last Company Supervisor
Last Pay Rate
Last Company Reason for Leaving
Company Name2
Company Address2
Position2
Dates2
Supervisor2
Pay Rate2
Reason for Leaving2
Reference Name1
Reference Title1
Reference Company1
Reference Phone1
Reference Address1
Reference Name2
Reference Title2
Reference Company2
Reference Phone2
Reference Address2
Reference Name3
Reference Title3
Reference Company3
Reference Phone3