Acme Health Care
Employment Application Applicant Information Full Name: Hale
Reese
Last
Date:5/4/2019
First
M.I.
2007 Heinken St.
Address:
Street Address
Apartment/Unit #
Apex
NC
27523
City
State
ZIP Code
919-777-7777
Phone:
Date Available:
5/4/2019
Email
[email protected]
Social Security No.:598763412
Desired Salary:$195, 520
Position Applied for: Pediatric Neurologist YES
NO
YES
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.? YES
NO
Have you ever worked for this company?
If yes, when? YES
NO
Have you ever been convicted of a felony? If yes, explain:
Education High School:
Panther Creek High School
Address:6770 McCrimmon Pkwy, Cary, NC 27519 YES
From:
2003
To:2007
College: East Carolina University
Diploma:: High School
Address:1001 E 5th St, Greenville, NC 27858 YES
To:2010
From:
2007
Other:
Duke University School of Medicine
From:
2010
NO
Degree:Masters
Did you graduate?
Address:201 Trent Dr, Durham, NC 27710 YES
To:2014
NO
Did you graduate?
Did you graduate?
NO
Degree:Doctorate
References Please list three professional references. Full Name: Kristi Milowic Company:
Relationship: Employer Phone:919-782-3456
Raleigh Neurology Associates 1
NO
Address:
1540 Sunday Drive, Raleigh, NC 27607
Full Name: Danielle Wyant
Relationship: Employer Phone:919-782-3456
Company:
Raleigh Neurology Associates
Address:
1540 Sunday Drive, Raleigh, NC 27607
Full Name: Traci Sheaffer
Relationship: Employer Phone:919-782-3456
Company:
Raleigh Neurology Associates
Address:
1540 Sunday Drive, Raleigh, NC 27607
Previous Employment Company:
Carolina Neuropsychological Service
Address:
1540 Sunday St, Raleigh, NC 27607
Job Title:
Neuropsychologist
Phone:919-859-9040 Supervisor: Alanna Conder
Starting Salary:$64,500
Ending Salary:$75,000
Responsibilities: Helped study the brain, and did research.
From:
2014
Wanted a job I wouldn’t get tired of Reason for Leaving:and a full time job.
To:2016
YES
NO
May we contact your previous supervisor for a reference?
Military Service Branch:
From:
Rank at Discharge:
To:
Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Date:5/4/2019
Signature:
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