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Employment application.

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INTRODUCTION

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Welcome to Epic Cardiovascular Services online employment application service. This service is intended to standardize and streamline the employment process for both applicants and employers. If you are an Epic Cardiovascular Services member and are applying for a position listed on our website, you may complete this online application, and the application results will be sent directly to the employer specified in the application.

Privacy Concerns:

Some sensitive personal information is collected during the application process. This information is stored securely on our servers and will only be shared with the employer who submitted the position. The results of your application will not be shared with any 3rd parties or recruiters without your consent.

Instructions:

Complete the online application making sure your fill out each item carefully.
Some items are required and other items are optional. It is recommend that you complete the optional items.
If you are not able to complete the employment application in one sitting, you may return and update your application three within (3) days.
If you have questions about the online application process, please contact our Human Resources Department.

Confirmation*

I have read and understand the Employment Application terms and instructions.

Yes

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Mobile Phone*

Home Phone

Emergency Contact*

First Name Last Name Relationship

Emergency Contact Number*

APPLICANT DETAILS

Authorization to work in the US*

Are you legally authorized to work in the US ?

Yes

POSITION INFORMATION

Title of Position*

Please enter the of tile of the positon(s) you are applying for.

Clinical Perfusionist

Chief Perfusionist

Traveling Perfusionist

Autotransfusionist

ECLS Specialist

Other

Location*

Please enter the name and/or location of the position you are applying for (hospital, city and state).

Salary Requirement*

Please enter your minimum annual salary requirement in U.S. Dollars. Please consider this carefully and input a realistic value.

Please enter a number from 5000 to 500000.

Start Date*

Please enter the date you would be available to begin work.

MM slash DD slash YYYY

Introduction Letter

This is not required, but it's a nice touch to add a personal letter to go along with your application.

Drop files here or

Accepted file types: pdf, jpg, png, bmp, doc, docx, Max. file size: 512 MB.

Resume Upload*

Drop files here or

Accepted file types: pdf, jpg, png, bmp, doc, docx, Max. file size: 512 MB.

EDUCATION INFORMATION

Name of High School

Name of College or Undergraduate School

Name of Graduate School or Perfusion Program

Perfusion School Graduation Date

MM slash DD slash YYYY

Degrees, Licenses and Certifications*

Please select any degrees and/or certifications that you have obtained.

CCP

BSN

CNOR

CPMBT

CCT

RRT

PhD

Other

Upload Documents

Please upload a copy of any degrees or certification that you have obtained.

Drop files here or

Accepted file types: pdf, jpg, png, bmp, doc, docx, Max. file size: 512 MB.

EMPLOYER #1

Employer #1*

This should be your most recent position.

Date Employment Began*

MM slash DD slash YYYY

Date Employment Ended*

MM slash DD slash YYYY

Job Title*

Employer Email

Employer Phone

Employer Address*

Street Address Address Line 2 City State ZIP Code

Reason for Leaving*

EMPLOYER #2

Employer #2

Date Employment Began

MM slash DD slash YYYY

Date Employment Ended

MM slash DD slash YYYY

Reason for Leaving

EMPLOYER #3

Employer #3

Date Employment Began

MM slash DD slash YYYY

Date Employment Ended

MM slash DD slash YYYY

Reason for Leaving

Employment Agreement*

Have you been employed under a written employment agreement within the last five (5) years?

Yes

This field is hidden when viewing the form

Restrictive Covenant

Does your employment agreement contain a covenant that in any manner restricts your employment during or after the termination of said written employment agreement?*

Yes

This field is hidden when viewing the form

Upload Employment Agreement

Please upload a copy of your current employment agreement.

Drop files here or

Max. file size: 512 MB.

FIRST REFERENCE

Reference Name*

First Last

Phone

Reference Email*

Address

Street Address Address Line 2 City State ZIP Code

Upload Reference Letters

Drop files here or

Accepted file types: pdf, jpg, png, bmp, doc, docx, Max. file size: 512 MB.

2ND REFERENCE

Reference Name*

First Last

Phone

Reference Email*

Address

Street Address Address Line 2 City State ZIP Code

3RD REFERENCE

Reference Name*

First Last

Phone

Reference Email*

Address

Street Address Address Line 2 City State ZIP Code

EEOC Questionnaire

The Equal Employment Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report. Completion of this form is voluntary and will not affect your opportunity or the terms and conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department. If you choose not to self-identify your race/ethnicity at this time, the federal government requires Perfusion.com to determine this information by visual survey and/or other available information.

Name:*

First Last

Job Title:*

Date Completed:*

MM slash DD slash YYYY

Gender:*

Male

Female

Prefer not to answer

Race/Ethnicity:*

(Please check one of the descriptions below corresponding to the ethnic group with which you identify.)

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.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the 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.

Native American or Alaska 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 maintains tribal affiliation or community attachment.

Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

Prefer not to answer

Veteran Status*

I am a Veteran

I am Not a Veteran

Prefer not to answer

Disability Status*

I have a disability

I do not have a disability

Prefer not to answer

Additional Comments

Please provide any additional detail that you feel is relevant in the comments box below.

Confidentiality

Would you like your application to be treated as "Highly Confidential"?

Yes

Signature*

Please sign your employment application by typing in your full name. The Company is an equal opportunity employer and does not discriminate against applicants or employees based on race, ethnicity, color, religion, sex, national origin, ancestry, creed, age, sexual orientation, gender identity, pregnancy status, marital status, medical condition, disability status, protected veteran status, or any other characteristic protected by law. In accordance with applicable law, the Company will provide reasonable accommodation to applicants or employees with physical or mental disabilities, provided that the accommodation does not pose an undue hardship on the Company’s operations. Should you need any such accommodation, please contact the Company’s People Operations Department for further information on the process and requirements. By signing below, I certify that I have provided to the Company true, complete and accurate information in this application. I authorize the Company to contact references listed in my application for employment reference checks. I understand that providing false or misleading information by me in any part of this application or during the hiring process may result in disqualification from employment consideration or, if hired, may be grounds for termination from the Company. I understand that nothing contained in this application constitutes an employment contract, either verbal or written, with the Company. If I am hired, I understand that my employment is “at will,” which means that either the Company or I may terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the Company has the authority to make any assurances to the contrary.

Phone

This field is for validation purposes and should be left unchanged.

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