Career Opportunities Employment Application Step 1 of 3 33% Your Personal InformationYour Name First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your PhoneYour Email Address Enter Email Confirm Email Position You're Applying ForPosition You're Applying For Any Available Receptionist Optician Optometric Assistant/Scribe Insurance Manager Wage RequirementsWhat Type Of Work Part Time Full Time Are you available to work during the hours listed below? (not all hours required)M 8 - 5, T 8 - 6:30, W 8 - 5, Th 8 - 7, F 7:30 - 5 Yes No Education and Employment HistoryEducation History(Required)Please list your previous education institution, the dates you attended and the degree you achieved.InstitutionLocationDegreeDate Graduated Add RemoveEducation History 2Please list your previous education institution, the dates you attended and the degree you achieved.InstitutionLocationDegreeDate Graduated Add RemoveYour Previous Employer(Required)Please list your previous employer, the dates you worked and the position you heldDatesName of OrganizationPhone NumberSupervisor Add RemoveStarting wage per hourFinal wage per hourDescription of Duties(Required)Reason for Leaving(Required)May we contact this employer?(Required)(We will only contact a previous employer after an interview and you wish to proceed with the hiring process.) Yes No Your Previous EmployerPlease list your previous employer, the dates you worked and the position you heldDatesName of OrganizationPhone NumberSupervisor Add RemoveStarting wage per hourFinal wage per hourDescription of DutiesReason for LeavingMay we contact this employer?(We will only contact a previous employer after an interview and you wish to proceed with the hiring process.) Yes No Your Previous EmployerPlease list your previous employer, the dates you worked and the position you heldDatesName of OrganizationPhone NumberSupervisor Add RemoveStarting wage per hourFinal wage per hourDescription of DutiesReason for LeavingMay we contact this employer?(We will only contact a previous employer after an interview and you wish to proceed with the hiring process.) Yes No ReferencesPlease list 3 work referencesName, Organization, Relationship, Phone #, Email, (We will only contact references after an interview and you wish to proceed with the hiring process.)Upload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB.Information Agreement(Required)The information provided in this application for employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I UnderstandSignature(Required)Date(Required) MM slash DD slash YYYY
