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Appointment
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Quick Appointment Form

Employment Application

Background Information

Name

Social Security #

Street Address

City

State

Zip

Telephone

Cellphone

Email

Date Available to Start

Please check:

What schedules are you available?

Desired Pay Rate: $

Position(s) Applied For:

How did you learn about Eye Partners and its affiliates?

Have you ever worked for Eye Partners and its affiliates before?

If Yes, Dates

Have you ever applied for work with Eye Partners and its affiliates before?

If Yes, Dates

Do any of your friends or relatives work here?

If Yes, name and relationship

Additional Screening Information

Can you provide proof of your right to work in the US?

Are you willing to work overtime?

Do you have reliable transportation?

Have you been convicted of, or plead guilty to, any crime within the last ten (10) years?
(Subject to applicable law, a conviction may not necessarily disqualify you from employment.)

If Yes, Please list ALL Convictions:

Are You At Least Eighteen (18) Years of Age?

Do you speak or write any foreign language?

Do you speak or write any foreign language?

Equal Opportunity Statement

Eye Partners and its affiliates provide equal employment opportunities to all employees and applicants without regard to race, color, creed, religion, sex, national origin, age, genetics, citizenship, disability, marital status, veteran status or any other protected status. This policy governs all areas of employment at Eye Partners and its affiliates, including recruiting, hiring, training, assignments, promotions, compensation, benefits, discipline and terminations.

Confidentiality Agreement and Employment-At-Will

I understand that if I am employed by Eye Partners and its affiliates for any duration, that such employment is of an AT WILL nature, meaning that I can end my employment relationship with Eye Partners and its affiliates at any time, for any reason or no reason at all, and that Eye Partners and its affiliates may terminate my employment at any time, for any reason, with or without cause, or for no reason at all. I also understand and acknowledge that completion of this application for employment does not guarantee me a personal interview, an offer of employment, or consideration for current or future openings, and that no commitments are made or implied regarding employment, and that this document does not create a contract of employment or otherwise, either express or implied, between Eye Partners and its affiliates and myself.

Furthermore, In the event I am hired by Eye Partners and its affiliates, I will not disclose, use or take, directly or indirectly, either during or after my employment, any property of Eye Partners and its affiliates or confidential or proprietary information concerning Eye Partners and its affiliate’s patients, vendors, employees and / or its business. I also agree to deliver promptly to Eye Partners and its affiliates, on request or on the date of termination of my employment, all documents, copies thereof, and other materials relating to any confidential or proprietary information that is the property of Eye Partners and its affiliates. Additionally, I agree to return all equipment, tools, instruments, identification badges / documents, materials, outstanding cash advances, wages paid in error, credit cards, uniforms, keys, software, hardware, or any other items furnished to me by Eye Partners and its affiliates. I hereby agree that if I do not return said items and/or cash, I authorize Eye Partners and its affiliates, or its agent, to deduct the value of such items from my paycheck. All deductions will be done in accordance with the law.

Attach Resume

Acknowledgement and Agreement:

Applicants Signature

Date

Roya1234 none 8:00am - 5:00pm 8:00am - 5:00pm 8:00am - 5:00pm 8:00am - 5:00pm 8:00am - 5:00pm Closed Closed optometrist # # # # https://meetmarlo.com/shop/00u4bju7jaRbsJ0X6297 https://denney.myclstore.com/ https://denney.myclstore.com/ https://denney.myclstore.com/ 121 St. Joseph Ave. Brewton, AL 36426 2518673635 607 Boll Weevil Cir #C Enterprise, AL 36330 3343476599 4340 Lafayette Street Marianna, FL 32446 8504822336 2826 Ross Clark Circle, Suite 102 Dothan, AL 36301 3347932633