In 150 characters or fewer, tell us what makes you unique. Try to be creative and say something that will catch our eye!
Have you ever worked for Prime Occupational Medicine? If yes, please list the location.
Please describe your educational experience. List any degrees, certifications, and/or licenses that you may currently have.
How many years have you worked in the medical field?
Do you have any experience with drug screenings, breath alcohol testing, pulmonary function testing, or EKGs?
* Yes No
List experience you have in the medical field, other than what you may have listed in the above question.
What are your salary expectations on an hourly basis? Please enter a range.
Are there any hours/days that you are unavailable to work?
Our clinical positions are scheduled on a rotation basis to be on-call. They have a "call out" phone that they would need to answer and at times may need to report to the clinic to see a patient. Would you be able to work an on-call schedule that would require nights and/or weekends?
* Yes No
Are you currently employed?
* Yes No
If currently employed, whom is your employer and give a brief explanation as to why you are seeking new employment.
Do you have a TWIC Card?
* -- No answer -- Yes No
Are you familiar with Workers Comp?
-- No answer -- Yes No
Do you have MRO experience?
-- No answer -- Yes NO
Have you ever interviewed with Prime Occupational Medicine?
* -- No answer -- Yes No
Are you familiar with DOT and BAT drug screens?
Clean driving record?
Do you have any Occupational Health experience?
Are you bilingual?
The following questions are entirely optional.
To comply with government Equal Employment Opportunity / Affirmative Action reporting regulations, we are requesting (but NOT requiring) that you enter this personal data. This information will not be used in connection with any employment decisions, and will be used solely as permitted by state and federal law. Your voluntary cooperation would be appreciated.
Decline to answer Female Male
Decline to answer White (Not Hispanic) African American/Black (Not Hispanic) Hispanic Asian Pacific Islander American Indian Native Alaskan Native Hawaiian Multi-racial
Invitation for Job Applicants to Self-Identify as a U.S. Veteran
A “disabled veteran” is one of the following:
a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
a person who was discharged or released from active duty because of a service-connected disability.
A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability
Voluntary Self-Identification of Disability Form CC-305
OMB Control Number 1250-0005
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if
you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Please check one of the boxes below:
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures,
providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.