Certified Medical Assistant - Chicago Outpatient Care Center

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Your Information

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Use your resume or LinkedIn Profile to fill in many of the fields on this application form.

Personal Information

How did you hear about us?

Additional Information

Have you ever worked or attended school under a different name?

If yes, please list all previous and nicknames that apply.

Are you authorized to work in the United States for any employer?

Can you provide legal verification of your legal right to work in the United States?

Have you ever been sanctioned by the Office of Inspector General of the Department of Health and Human Services (HHS/OIG) or the Government Services Administration (GSA) or excluded or suspended from participation in any federal or state health care program?

The State regulations and the Joint Commission require that all registered, licensed and certified employees submit proof of same to his/her employer. Copy required upon employment. (review language to see if primary source acceptable) If you are not currently registered, licensed or certified, are you eligible?

If yes, when do you sit for your examination?

What shifts are you available to work?


Have you ever been employed by Cancer Treatment Centers of America or any of its affiliates?

If Yes, please provide the dates, position(s) and location(s)

Do you have any friends or relatives currently employed by Cancer Treatment Centers of America or any of its affiliates?

If Yes, please enter their name(s) and locations

Are you willing to relocate?

Resume and Questions

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Resume Text

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You can use this text area for a cover letter or any supplementary information you would like to provide about your career goals, availability, best time to contact you, etc.


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Work and Education History

Employment History

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Description of Work and Responsibilities

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Education History

Please Provide your highest completed education

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Other History

Certificates and Licenses

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Applicant Acknowledgement

I certify that the information contained in this application is correct to the best of my knowledge and I understand that any falsification, misrepresentation or omission on this application is grounds for refusal to hire or if hired dismissal. I authorize any of the persons or organizations referenced in this application to give the Company any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise with regard to any of the subjects covered by this application and release all such parties and the Company from all liability for any damage that may result from furnishing such information. I authorize the Company to request and receive such information.

I acknowledge that any offer of employment, or my acceptance of any employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the Company or myself. I understand that this application and any other documents which I may receive are not contracts of employment. I further understand that no representation of the Company other than specifically identified officers has any authority to enter into any agreement for employment for any specified period of time or to assure any other personnel action, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or to make any agreement contrary to the foregoing.

Candidate Sign Off

I certify that all of the information in this application is true and correct as of this date.

By typing my first and last name in the space provided, I hereby certify that I agree with the above statements and policies

By entering today's date in the space provided, I again certify my agreement

Application Review