SCMC Staff Application (Blank)

SCMC STAFF APPLICATION FORM

(ooc information Times online, reason you like medical rp.... anything special we need to know about backstory etc))


What position are you applying for today?
Nursing, Lab Tech, orderly, Doctor, mental health services, specialist? please list
____________________________________________________________________________________________________________

1. Personal Information:
a. First Name
b. Middle Initial
c. Last Name
d. Date of Birth


2. Mailing Address:
a. Address


3. Contact Information:
a. Select Phone Type
b. Personal Email
c. Work Email if other than hospital.
(your IC information never RL)

The following sections are optional and do not have to
be completed to save your profile. The SCMC Staff uses the following fields for research and administrative tasks.

Please enter any information you wish to share before
saving your profile.

4. Professional Information:
a. Primary Employer Type
b. EMS Employment Status
c. Primary EMS Responsibilities
d. EMS Service Type
e. Volunteer Status

5. Demographic Information:
a. Highest Level of Education Completed
b. Sex
c. Ethnicity