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Application Form


 

The fields marked with an * are required.Please do not press 'Submit' button twice.


Email Address: *

Verify Email Address: *

First Name: *

Middle Name:

Last Name: *

Address: *

Address:

City: *

Province/State: *

Postal/Zip Code: *

Preferred Contact Number: *

Home Work Cell

Home Phone:

Work Phone:

Ext:

Cell Phone:

Fax:

Religion: *

Last 4 Digits of SS#/SI#:

Referred By: *

Referral Code : (if known)

Employment Category: *

Preferred Schedule: *

Days: Shift:


MT EDUCATION    (For US applicants only)


Enrolled in Partner In Education Program:

Yes No

Graduated Partner In Education Program:

Yes No

Partner In Education Name:

Year Graduated/Graduating:

Enrolled In Other MT Program:

Yes No

Graduated Other MT Program:

Yes No

Other MT Program Name:

Year Graduated/Graduating:


EDUCATION    


School Name (XII or GED) : *

Medium of Instruction : *

Year of Passing: *

Degree:

University:

Year of Passing:


EMPLOYMENT HISTORY


Have you ever worked for Atpdocs before?

Yes No



List Past and Current Employers for medical transcription positions.

Dates (MM/DD/YY)

Organizations

1. From To

2. From To

3. From To

4. From To

5. From To

6. From To


MEDICAL TRANSCRIPTION EXPERIENCE (MT Education Should Not Be Listed As Experience)


List the number of years you transcribed the following reports.

History & Physical

Consultation

Operative Report

Discharge Summary

Emergency Room

Progress Notes

Foreign Accents

Outpatient Surgery

Radiology

MRI

Nuclear Medicine

Radiation Oncology

Cardiac Laboratory

GI

Oncology

Pathology


By submitting this form, I certify that all of the information on this application is true, correct, and complete. I understand that false, misleading, incomplete or omitted information is sufficient cause for and may result in the rejection of my application, or my termination if hired, and I agree not to challenge my discharge or the Company’s decision not to hire me on this basis.