Careers — Elite Medical Billing

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If interested in any of our available positions, please complete the below application. We look forward to speaking with you!

Date

YYYY

Full Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

YYYY

Social Security Number

Position Applied For

Desired Salary

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

Have you previously worked for Elite Medical Billing LLC?

If employment was under a different name, please indicate name used:

Have you ever been convicted of a crime other than a minor traffic offense?

If you answered yes to the above question, please explain.

Are you able to perform the essential requirements for the position applied for?

If no, are there reasonable accommodations that can be made for you to perform the essential job functions of the position applied for?

On what date would you be available for work?

YYYY

Please state any additional information you feel may be helpful to us in considering your application for employment.

High School Attended

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

From

YYYY

College Attended

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

From

YYYY

Licenses or Certifications

Professional License | State of Issuance | License Number | Expiration Date

Licenses or Certifications

Professional License | State of Issuance | License Number | Expiration Date

Licenses or Certifications

Professional License | State of Issuance | License Number | Expiration Date

Professional Reference

Full Name | Company | Title | Phone Number | Address

Professional Reference

Full Name | Company | Title | Phone Number | Address

Professional Reference

Full Name | Company | Title | Phone Number | Address

Previous Employment

Company Name

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Salary

Ending Salary

Job Responsibilities

From

YYYY

Reason for Leaving

May we contact your previous employer for a reference?

Previous Employment

Company Name

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Salary

Ending Salary

Job Responsibilities

From

YYYY

Reason for Leaving

May we contact your previous employer for a reference?

Military Service

Branch

From

YYYY

Rank at discharge

Type of discharge

If other than honorable, please explain

Disclaimer and Signature (Type your full name & date signed)

I hereby certify that all the facts set forth in this application for employment are true and complete to the best of my knowledge. I agree that if the information given in my application, resume, or any other materials, or during any interview, is found to be false in any way, it shall be considered sufficient cause for denial of employment or termination of employment with Elite Medical Billing LLC. I authorize past employers, references, and any other person to answer all questions asked concerning my employment, education, general reputation, character, personal characteristics, habits and other qualities pertinent to the assessment of my qualifications for employment and hereby release these individuals from any and all damages arising from furnishing any requested information. I hereby understand and acknowledge, in consideration of my employment, I agree to abide by the rules and policies of this Company, including any changes made from time to time, and agree that my employment and compensation can be terminated "AT WILL" with or without cause, with or without notice, at any time, at the option of either the Company or myself.

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