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Name *

First

Last

Phone *

Email *

Date Of Birth *

Preferred Clinic (Choose all that apply) *

• Bartlesville
• Bixby
• Inola
• Pryor
• Sapulpa
• Tulsa (31st and Garnett)
• Tulsa (91st and Sheridan)

Are you okay with swabbing for covid? *

• Yes
• No

Are you currently working? *

• Yes
• No

When is your soonest start date? *

Do you have any medical licensure/certifications? *

• Yes
• No

Why are you interested in this position? *

Have you ever swabbed for Covid before? *

• Yes
• No

Why did you leave your last job? *

Can you work Monday-Friday 8 AM to 7 PM? *

• Yes
• No

If you cannot work the hors above, what hours can you work?

How much were you making at your former job? *

What are your hourly pay expectations? *

Can you pass a drug screen? (THC is only allowed if you have a medical marijuana card) *

• Yes
• No

Can you pass a background check? *

• Yes
• No

Are you okay working outside? *

• Yes
• No

How do you work with others? *

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