Apply to Join Pioneer Medical Group

Please complete this form and upload your CV.

 

CONTACT INFORMATION

 
 

Please feel free to upload your current Non-Compete Contract, if you would like our team to review.

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You may enter one or multiple previously used names, including legal names or nicknames, by separating them with commas

 
 
 
 
 
 
 
 
 

 

PREVIOUS EMPLOYMENT

 
 
 
 
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LICENSES AND CERTIFICATIONS

 
 
 

 

QUESTIONS

 
 
 
 
 
 
 
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PHYSICIAN QUESTIONNAIRE

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

EEOC - Voluntary Self-Identification Survey

This employer is required to notify all applicants of their rights pursuant to federal labor laws. For further information, please review this notice from the Department of Labor: EEO is the Law poster www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm You may have additional rights pursuant to recent amendments to federal labor laws. Please review these protections from the EEO is the Law Supplement: www.eeoc.gov/employers/upload/eeoc_gina_supplement.pdf This employer is subject to certain nondiscrimination and/or affirmative action recordkeeping and reporting requirements which require the employer to invite applicants to voluntarily self-identify their race/ethnicity and gender.

 
 

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. American Indian or Alaskan Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

 

Veteran Status

We ask all candidates to provide the information listed below. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information you provide will be kept confidential and may only be used in accordance with applicable federal, state, and local laws and regulations.

 
 

Voluntary Self-Identification of Disability

We ask all candidates to provide the information listed below. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information you provide will be kept confidential and may only be used in accordance with applicable federal, state, and local laws and regulations.

 
 

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

 

 

REFERENCES

Minimum of 3 references are required

 
 
 
 
 
 
 
 
 
 

 

Covid-19

 

Have you received a Covid-19 vaccine?

 

 
 

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