What are the responsibilities and job description for the Front Office Receptionist position at Ankle & Foot Center of Fox Valley, Ltd.?
Employment Application
Name: ___________________________________________ Date: ______/_______/_______
Maiden Name: ___________________________________ S.S #: _______-_______-_______
Address: ____________________________________ Telephone: ______________________
City/State/Zip: ____________________________________________________________
Email: _____________________________________________________________________
Education [Highest Attained]: Primary High School College
Are there any days or hours you are unable to work: Yes No
If yes, what days: __________________________ What hours: ___________________________
Expected Salary: $___________/hour When can you start: ________/________/_______
Do you have your own transportation to work? _____________________________________
Can your vacation time be arranged most anytime? __________________________________
Will you give at least 3 weeks prior to leaving? _______________________________________
HOBBIES & SPECIAL INTERESTS:
1.___________________________ 2.__________________________ 3.___________________________
Health Status: ______________________ Any health limitations? ________________________
Allergies: _______________________ Date of last medical exam: ______/______/_______
REFERENCES OTHER THAN PAST EMPLOYER AND RELATIVES:
NAME ADDRESS PHONE NUMBER RELATIONSHIP
1. _____________________________________________________________________________________
2._____________________________________________________________________________________
3.______________________________________________________________________________________
QUALIFICATIONS:
Computers: _________ Scheduling appointments: _________ Use of Medical Terminology __________ Use of Podiatric terms: ____________
Visa/MC/Discover credit card machine ________________________
PAST EMPLOYMENT HISTORY
1. Employer: __________________________________________________________________________
Address: _____________________________________________________________________________
Phone number: _______________________________________________________________________
Position held and duties: _____________________________________________________________
Employed dates: ____/____/____ to ____/____/____ Reason for leaving: __________________
2. Employer: __________________________________________________________________________
Address: ______________________________________________________________________________
Phone number: _______________________________________________________________________
Position held and duties: _____________________________________________________________
Employed dates: ____/____/____ to ____/____/____ Reason for leaving: __________________
I hereby certify that all the above statements are true and accurate. I further give my consent to have the above verified prior to employment. Any misrepresentation will be due cause for release from employment with forfeiture of employee benefits accrued.
Date: _________________ Signature of applicant: ________________________________________
Please return to
Nancy A. Jagodzinski, D.P.M.
Ankle & Foot Center of Fox Valley, Ltd.
620 N. River Rd. Suite 104
630.778.7670
Fax: 630.778.7671
feetfxn1@gmail.com
Job Type: Full-time
Pay: From $16.00 per hour
Medical Specialty:
- Podiatry
Schedule:
- 8 hour shift
- Afternoon shift
- Day shift
- Evening shift
- Monday to Friday
- Morning shift
Work Location: In person
Salary : $16