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1.2.3
Release Date:
09/30/2020
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Present or Last Employer Details
Employer Name
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Describe your duties.
What job position did you hold with this employer? Example: RN, CPA, CPN, Direct Care Worker, etc. [optional]
If applicable, did you use any specialized skill for this job? Describe. [optional]
If applicable, what kind of electronic medical records systems have you used? [optional]
Was this a temporary position or permanent?
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Describe your experience with this employer.
If we were to contact your previous employer, which areas of your work would they say need the most improvement? [optional]
Why did you leave this employer?
Did you work for this employer under a different name from the one you have already provided? If so, please enter here. [optional]
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Second Employer Details
Name of second most recent employer.
Employer Address [optional]
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Name of supervisor
Supervisor's Phone [optional]
Start Date
End Date
Describe your duties.
What job position did you hold with this employer? Example: RN, CPA, CPN, Direct Care Worker, etc. [optional]
If applicable, did you use any specialized skill for this job? Describe [optional]
If applicable, what kind of electronic medical records systems have you used? [optional]
Was this a temporary position or permanent?
Select...
Temporary
Permanent
Describe your experience with this employer.
If we were to contact your previous employer, which areas of your work would they say need the most improvement? [optional]
Why did you leave this employer?
Did you work for this employer under a different name from the one you have already provided? If so, please enter here. [optional]
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Third Employer Details
Name of third most recent employer
Employer Address [optional]
City
State
Zip
Name of supervisor
Supervisor's Phone [optional]
Start Date
End Date
Describe your duties.
What job position did you hold with this employer? Example: RN, CPA, CPN, Direct Care Worker, etc. [optional]
If applicable, did you use any specialized skill for this job? Describe [optional]
If applicable, what kind of electronic medical records systems have you used? [optional]
Was this a temporary position or permanent?
Select...
Temporary
Permanent
Describe your experience with this employer.
If we were to contact your previous employer, which areas of your work would they say need the most improvement? [optional]
Why did you leave this employer?
Did you work for this employer under a different name from the one you have already provided? If so, please enter here. [optional]
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Education
What is your highest level of education?
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GED
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What is your highest degree earned?
What were/have you been doing between your most recent graduation and any job(s) you currently have? [optional]
Can you provide references, education and/or any physical documents? If yes, which ones? [optional]
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Axion Representative
Please choose the Axion Representative that you are working with...
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Resume
Please copy and paste your resume to the area below.
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Skills
Please indicate any languages other than English in which you are moderately to highly proficient. [optional]
What certifications, licenses and/or documnets do you have? Are they current? [optional]
If you are applying for an advertised position, why are you a great fit for this position? [optional]
What can you bring to our company that other candidates cannot? [optional]
Please indicate any specialized skill sets not previously indicated. [optional]
Do you have any specialized skills that you have used professionally, if at all? [optional]
What computer programs are your familiar with or best at? [optional]
What kind of electronic medical record systems have you used, if any? [optional]
What other certifications, Licenses and or documents do you have that were not listed? Are they current? [optional]
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Questions
Can you give an example of a stressful situation at work, and how you handled it? [optional]
What are your main strengths?
What are your weaknesses? [optional]
Please tell us about a situation in which you made a material improvement to a company you have worked for. [optional]
Can you describe a job-related project that you sucessfully completed? [optional]
Ideally, what type of position are you currently looking for?
What type of positions, both short term and long term, are you looking for? [optional]
What are the most important considerations you have when considering a potential position or employer?
Have you been on any interviews recently? If so, where and who did you meet?
If not, have you been on any temporary assignments recently? What agency were they through and to whom did you report? [optional]
Are you currently interviewing for other positions or registered with another staffing firm?
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Availability
What locations are you open to working in?
Would you be willing to relocate or travel if necessary? Up to what distance?
Are you immediately available for any potential employment?
How soon can you start after accepting a position?
Do you have any preplanned vacations or days off needed?
Would you be willing to work overtime as necessary?
Are you available for same day placements? [optional]
What is your availability? Weekdays? Weekends? Overnights?
What is your interview availability?
Are there any days in the next 2 weeks you CAN'T interview?
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Background
Do you know of anyone who may be looking for a job in healthcare?
Have you interviewed or submitted your resume to any Company?
How did you find your last position?
Were your last positions through a staffing firm?
Please feel free to provide referrals to us for anyone you may know who is also seeking employment. We offer a referral bonus for every referral that we place on an assignment. Name and contact number.
How did you hear about Axion? Please be specific.
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