Locust Grove
770-626-5740
Adult & Pediatrics

Dial: 770-626-5740

Decatur
770-626-5760
Adult & Pediatrics

Dial: 770-626-5760
Facebook Twitter

No Appointment Necessary for Urgent Care

Careers

All qualified applicants will receive consideration for employment regardless of race, color religion, sex, age, sexual orientation, national origin or disability.

All offers of employment are contingent on a successful criminal background check, credit check, reference check, education verification, and passing an employee drug screen. CorrectMed is a certified Drug-Free Workplace and
reserves the right to participate in random drug testing.

Employment Information
Last Name:    First Name:    MI:  
Address:     City:    State:    Zip:  
Telephone:    Cell Phone:    Email:  
Are you currently employed? Yes No
Position for which I'm applying:
Hours: Full Time
Part Time
PRN
Any Status
Time: Days
Nights
Any Shift
Can you travel if a job requires it? Yes No
Do you have a valid drivers license? Yes No
Have you ever been arrested? Yes No
If Yes, please explain in detail:
Have you ever been convicted of a felony or misdemeanor where disposition was a conviction, a plea of nolo contendere (no contest), or first offender treatment? Yes No
If Yes, please explain in detail:
Have you ever had a professional license revoked, reviewed, suspended or limited in any way? Yes No
If Yes, please explain in detail:
Have you ever been dismissed or asked to resign from any job? Yes No
If Yes, please explain in detail:
References
Please provide the name, address and telephone number of three professional references (Note, lack of current information will slow and/or eliminate the employment process).
Name Company Address Phone Number Relationship
Name Company Address Phone Number Relationship
Name Company Address Phone Number Relationship
Name Company Address Phone Number Relationship
Employment Experience
Please list beginning with your present or most recent job. Include military service assignment and volunteer activities.
Note: YOU MAY NOT SUBMIT A RESUME IN LIEU OF COMPLETING THIS WORK HISTORY
Employer Address Job Title Reason for Leaving
Dates Employed From:   To:  
Work Performed
Employer Address Job Title Reason for Leaving
Dates Employed From:   To:  
Work Performed
Employer Address Job Title Reason for Leaving
Dates Employed From:   To:  
Work Performed
Special Skills, Licenses, Registration or Certifications and any Qualifications (including language skills, typing skills, and business equipment or machine operating skills) We only accept CPR/BLS/ACLS from the American Heart Association.
Areas of your position(s) which you have liked most and why:
Areas of your position(s) which you have liked least and why:
Education
High School
School Name Address City, State, Zip
Years Completed
Diploma/Degree
Describe Course of Study
Describe specialized training, skills, extra-curricular activities
College/University
School Name Address City, State, Zip
Years Completed
Diploma/Degree
Describe Course of Study
Describe specialized training, skills, extra-curricular activities
Graduate/Professional
School Name Address City, State, Zip
Years Completed
Diploma/Degree
Describe Course of Study
Describe specialized training, skills, extra-curricular activities
EMT/Paramedic Nursing School
School Name Address City, State, Zip
Years Completed
Diploma/Degree
Describe Course of Study
Describe specialized training, skills, extra-curricular activities
APPLICANT'S CERTIFICATION AND AGREEMENT
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered a sufficient cause for dismissal. CorrectMed is hereby authorized to make any investigation of my prior educational work and criminal histories. By submitting this application I indicate an understanding that my ability to work is contingent on security clearance at the designated facility.
AUTHORIZATION TO RELEASE INFORMATION
I have completed and application for employment with CorrectMed. I authorize my former employers to give any information regarding my employment and/or answer any questions regarding my employment. I hereby release them from any damages whatsoever for issuing the same.
May we contact your present employer? Yes No
By submitting this form you are authorizing us to confirm information and contact prior employers, even though we may not contact your present employer.