Medical Supplies - Repair and Sales Application for Employment

Name * First Last
Phone * - ### - ### ####
Email *
What City do you live in? How long have you lived there? *
Are you eligible to work in the United States?
*
Do you have independent and reliable transportation? *
What is the highest level of education you have completed? *
*
List any certificates or degrees you have. *
Are you currently employed? If so, How many hours/ week?
*
How many hours are you looking to work? What hours are you available to work? Are you available to work on Saturdays?
*
Are you able to pass a FL Level 1 background check?
*
Are you able to pass a drug test?
*
Are you able to lift 50 lbs? *
Are you able to climb a ladder on a daily basis? *
Are you able to stand for most of the work day
*
Please describe your driving record.
*
What is your desired hourly pay rate?
*
About You:
Describe any experience or knowledge with: Medical Equipment, Home Health Supplies, Orthopedic Supports, or any understanding of body mechanics or different medical conditions?
*
Describe any experience with being able to manage multiple phone calls at once, taking & filling orders, organization of paperwork, HIPPA. *
Describe any experience with working in a retail environment. - List the top 3 criteria to being successful in a retail environment.
Describe any Mechanical skills (if any) that you might have. *
What else would you like us to know about you?
*
Applicant Assessment

Please fill out the section below to the best of your ability: Honor section: No quick google search or calculator please.

I am the type of person that: *
	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
prefers to follow a plan
prefers to create a plan
enjoys working alone until a project is finished.
likes to work as part of a team
likes to interface with customers
likes to manage people from the background
is detail oriented
is big picture oriented.
relies on repition to learn new tasks.
figures things out before I ask a question.
can concentrate on many tasks at once

Which Number should follow in this sequence: 144, 121, 100, 81, 64, *
Timothy is four years old. Janet is three times as old as timothy. When Timothy turns twelve, how old will Janet be? *
*
If a and b are such numbers that a >0 and b <0, then which one of the following is always correct? *
a+b>0 a-b>0 a+b<0 a-b<0 I do not Know
What would be the opposite of Lateral Epicondylitis?

Trick Question?
Enter a description for your section break