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Employment Application Form
To apply, complete the form below.
Step
1
of
7
14%
I currently reside in the United States
Yes
No
We are currently only accepting applications from support staff who have residence in the United States.
General Info
Today's Date
MM slash DD slash YYYY
Name
First
Last
Have you received a high school diploma or equivalent?
*
Yes
No
Thank you for your interest
We are currently only accepting applications from people with a high school diploma or equivalent. If you have any questions or concerns, you can reach out to us on our
contact page.
Contact Information
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Applicant Information
Date Available
MM slash DD slash YYYY
What position are you interested in applying for?
Patient Care Representative
Medical Assistant
Limited Practical Radiology Technologist (LPRT) Specialist
Finance Team Specialist
Family Physician
Mid-level provider
Are you a Certified Medical Assistant?
Yes
No
Where did you obtain your Medical Assistant license?
*
What year did you obtain your Medical Assistant license?
*
Do you have a current LPRT license?
*
Yes
No
If YES Where did you obtain your LPRT license?
*
Desired Salary
Check all that apply
Full Time
Part Time
I can work during the day
I can work evenings
I can work weekends
I can work holidays
Are you a U.S. Citizen?
Yes
No
If you are not a citizen, are you authorized to work in the US?
*
Yes
No
Have you ever worked for this company?
Yes
No
When did you work here?
Education & Work Experience
Check all that apply
Graduated High School
Attended College or University
Other
Resume Upload
*
Accepted file types: pdf, Max. file size: 75 MB.
Make sure to include all education and work experience.
Professional References
Please enter 3 professional references below (Required)
Reference 1
Name, Relationship, Company, Phone
Reference 2
Name, Relationship, Company, Phone
Reference 3
Name, Relationship, Company, Phone
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
*
Yes
No
I understand that by checking "yes" below authorizes Exodus to perform a background check, a drug test, and credit check after an employment offer is made. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release from employment.
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HOME
FIND A DOCTOR
SERVICES
Family Practice
Urgent Care
Imaging
Mammography
Podiatric Medicine
Ear, Nose and Throat
Sleep Apnea Information
Endoscopy
Gastroenterology
Behavioral/Mental Health
Educational Classes
PATIENT PORTAL
CAREERS
ABOUT
Locations
Patient-Centered Medical Home
Resources
Covid-19 Information
About Exodus
Exodus Blog
How we’re improving your healthcare
PATIENT SURVEY
CONTACT
Call (801) 250-9638
PATIENT PORTAL SIGN IN
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