Main Office #: 620-783-1732 | Billing Questions: 620-783-1732
Web: premier.ptstest123.com
Premier Surgical Institute
1619 K Highway 66, Kansas 66739
copyright © Premier Surgical Center 2012. Design By PILR

Premier Surgical Institute Employment Application

Personal Information
Date:
 
* First Name:
* Middle Initial:
* Last Name:
* Street Address:
Apartment/Unit #:
* City:
* State:
* Zip Code:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
* Email Address:
Employment Desired
* Position Applied For:
* Referral Source?
* Desired Salary:
* On What Date Would You Be Available For Work:
v
 
* Are you available to work (Shift):
* Are you available to work (Time of Day):
* If hired, would you be able to travel or work overtime as needed?:
* If hired, do you have a reliable means of transportation to and from work?:
 
* - Required
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