Knoxville Orthopaedic Clinic is an equal opportunity employer. Knoxville Orthopaedic Clinic does not discriminate in employment with regard to race, color, religion, national origin, age, sex, sexual orientation, marital status, military or veteran status, or any other characteristic protected by law.Name(Required) First Last Phone(Required)Email(Required) Date(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP code Are you legally eligible to work in the U.S?(Required) Yes No Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)(Required) Yes No Have you ever been terminated from employment or asked to resign by an employer?(Required) Yes No If yes, please provide company names and details.(Required)Have you ever been convicted of a crime, excluding minor traffic offenses?(Required) Yes No Please provide details.(Required)Have you ever been subject to investigation by a state licensing or medical board?(Required) Yes No Please provide details.(Required)Are you seeking full-time, part-time or PRN?(Required) Full-Time Part-Time PRN EMPLOYMENT DESIREDPosition applying for(Required)Accounting TeamMRI Office TeamRevenue Cycle TeamCertified Radiologic TechnologistCertified Athletic TrainerMedical AssistantSurgical AttendantRegistered NurseMedical Front OfficeSterile Processing TechMedical Front Office SpecialistAppointment SchedulingCertified Surgical TechnicianPhysical Therapy TeamOrthopaedic Cast TechnicianOtherWhat is the name of the position?(Required)Preferred Locations(Required)HarrimanKnoxville Orthopaedic Surgery CenterLakewayMaryvilleNorthOak RidgeSeviervilleTurkey CreekUniversity Orthopaedic Surgery CenterUT Research ParkWeisgarberWestThis field is hidden when viewing the formApplying For Accounting Team Appointment Scheduling Certified Athletic Trainer Certified Radiologic Technologist Certified Surgical Technician Medical Assistant Medical Front Office Medical Front Office Specialist MRI Office Team Orthopaedic Cast Technician Physical Therapy Team Registered Nurse Revenue Cycle Team Sterile Processing Tech Surgical Attendant Date you can start(Required) MM slash DD slash YYYY Are you currently employed?(Required) Yes No May we reach out to this employer?(Required) Yes No Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?(Required) Yes No ReferralHow did you hear about us?(Required) Walk-in Advertisement Referral Other Have you ever worked for KOC before?(Required) Yes No Do you know anyone who works for our company?(Required) Yes No If yes, who?EducationEducationName and location of schoolDegree ReceivedSubjects Studied/Major Add RemoveReferencesNameAddressPhoneEmailCompanyYears Acquainted Add RemoveEmployment History 1FromToEmployer NamePhoneJob TitleAddressImmediate supervisor and titleSummarize the nature of work performedReason for leavingMay we reach out to this employer?(Required) Yes No Add Another Job? Add Job Number 2 Employment History 2FromToEmployer NamePhoneJob TitleAddressImmediate supervisor and titleSummarize the nature of work performedReason for leavingMay we reach out to this employer?(Required) Yes No Add Another Job? Add Job Number 3 Employment History 3FromToEmployer NamePhoneJob TitleAddressImmediate supervisor and titleSummarize the nature of work performedReason for leavingMay we reach out to this employer?(Required) Yes No Add Another Job? Add Job Number 4 Employment History 4FromToEmployer NamePhoneJob TitleAddressImmediate supervisor and titleSummarize the nature of work performedReason for leavingMay we reach out to this employer?(Required) Yes No Add Another Job? Add Job Number 5 Employment History 5FromToEmployer NamePhoneJob TitleAddressImmediate supervisor and titleSummarize the nature of work performedReason for leavingMay we reach out to this employer?(Required) Yes No Please read carefully before signing.Consent(Required) Consent and Acknowledgment StatementI understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Knoxville Orthopaedic Clinic to hire me. If I am hired, I understand that either Knoxville Orthopaedic Clinic or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Knoxville Orthopaedic Clinic has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Knoxville Orthopaedic Clinic true and complete information on this application. No requested information has been concealed. I authorize Knoxville Orthopaedic Clinic to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.Date MM slash DD slash YYYY Upload Signature(Required)Max. file size: 2 GB.
