Personal Info
First Name [First_name]
Middle Initial [middle_name]
Last Name [Last_name]
Contact
Address [address]
City [city]
Zip [zip]
State [Select_state]
Home Phone [home_phone]
Cell Phone [cell_phone]
Work Phone [work_phone]
Preferred Phone [Preferred_Phone]
E-mail (leave blank if no e-mail)
Email [email_address]
Position type [position_type]
Acute, Radiology, Rad/Onc, ER, Clinic or Pathology
Account type [account_type]
Time zone [time_zone]
Days/ Hours Available to Work
No Preference [No_Preference]
Monday [Monday]
Tuesday [Tuesday]
Wednesday [Wednesday]
Thursday [Thursday]
Friday [Friday]
Saturday [Saturday]
Sunday [Sunday]
Have you ever worked for softscript [work_before]
If yes, What year [wyear]
I can transcribe 135 lines [transcribe]
I can maintain a minimal or 98% accuracy [maintain]
How many hours can you work weekly? [hours]
Can you work nights [nights]
Salary Desired? [Salary]
How did you learn about this position? [position]
Employment Desired? [employment]
EDUCATION AND OTHER INFORMATION
High School
TYPE OF SCHOOL [srow_1]
NAME OF SCHOOL [srow_2]
LOCATION (Complete mailing address) [srow_3]
YRS. COMPLETED [srow_4]
MAJOR & DEGREE [srow_5]
College
TYPE OF SCHOOL [crow_1]
NAME OF SCHOOL [crow_2]
LOCATION (Complete mailing address) [crow_3]
YRS. COMPLETED [crow_4]
MAJOR & DEGREE [crow_5]
Bus. or Trade School
TYPE OF SCHOOL [brow_1]
NAME OF SCHOOL [brow_2]
LOCATION (Complete mailing address) [brow_3]
YRS. COMPLETED [brow_4]
MAJOR & DEGREE [brow_5]
Professional School
TYPE OF SCHOOL [prow_1]
NAME OF SCHOOL [prow_2]
LOCATION (Complete mailing address) [prow_3]
YRS. COMPLETED [prow_4]
MAJOR & DEGREE [prow_5]
Emergency contacts list one
Name [emergency_name1]
Address [emergency_address1]
Telephone [emergency_tel1]
Emergency contacts list Two
Name [emergency_name2]
Address [emergency_address2]
Telephone [emergency_tel2]
Have you ever been convicted of a crime [crime]
If yes please explain [explanation]
Emergency contacts list one
Name [emergency_name1]
Address [emergency_address1]
Telephone [emergency_tel1]
Emergency contacts list Two
Name [emergency_name2]
Address [emergency_address2]
Telephone [emergency_tel2]
Have you ever been convicted of a crime [crime]
If yes please explain [explanation]
Professional references other than a relative list one
Name [emergency_name3]
Position [emergency_Position1]
Address [emergency_address3]
Telephone [emergency_tel3]
Professional references other than a relative list Two
Name [emergency_name4]
Position [emergency_Position2]
Address [emergency_address4]
Telephone [emergency_tel4]
application [application]
MILITARY
Have you ever been in the Armed Forces? [force]
Are you now a member of the National Guard? [Guard]
Specialty [Specialty]
Date Entered [DateEntered]
Discharge Date [DischargeDate]
Date Entered [DateEntered]
Work Experience
Job One
Name of Employer [Employername1]
Name of last supervisor [Supervisorname1]
Complete Address [CompleteAddress1]
Phone Number [dffPhone1]
Employment Dates
Start Date [stardate1]
End Date [enddate1]
Salary
Start Salary [startsalary1]
Final Salary [finalsalary1]
Job Title [JobTitle1]
Reason for leaving? (be specific) : [leavingReason1]
Description of jobs [comment1]
Number of lines transcribed per hour/day
Last Audit Score: [Score1]
Hour- [audithour1]
Day- [auditday1]
Job Two
Name of Employer [Employername2]
Name of last supervisor [Supervisorname2]
Complete Address [CompleteAddress2]
Phone Number [dffPhone2]
Employment Dates
Start Date [stardate2]
End Date [enddate2]
Salary
Start Salary [startsalary2]
Final Salary [finalsalary2]
Job Title [JobTitle2]
Reason for leaving? (be specific) : [leavingReason2]
Description of jobs [comment2]
Number of lines transcribed per hour/day
Last Audit Score: [Score2]
Hour- [audithour2]
Day- [auditday2]
Job three
Name of Employer [Employername3]
Name of last supervisor [Supervisorname3]
Complete Address [CompleteAddress3]
Phone Number [dffPhone3]
Employment Dates
Start Date [stardate3]
End Date [enddate3]
Salary
Start Salary [startsalary3]
Final Salary [finalsalary3]
Job Title [JobTitle3]
Reason for leaving? (be specific) : [leavingReason3]
Description of jobs [comment3]
Number of lines transcribed per hour/day
Last Audit Score: [Score3]
Hour- [audithour3]
Day- [auditday3]
Rate your computer skills on a scale of 1-5. 5 being the highest [Rateskills]
List the software programs you are proficient with: [Listsoftware]
May we contact your present employer? [contactemployer]
Did you complete this application yourself? [confirmation2]
If not who did? [whodid]
copy and paste your resume here [Resume]
Your Experience Profile
Please list your years of experience in each area:
Multi Specialty Clinics [SpecialtyClinics]
Acute Care [AcuteCare]
Radiology [Radiology]
Pathology [Pathology]
What size facilities have you worked in? [facilitiessize]
What is your average daily production? [dailyaverage]
Please rate your experience level
H&P [H_P]
Clinic/Progress Notes [Progress]
Consult [Consult]
OP [OP]
Cardiac Cath [Cardiac]
DS [DS]
ER [ER]
Radiology [Radiology2]
Pathology [Pathology2]
Cardiology(EKG, ECHO, Holter) [Holter]
Neurodiagnostic Studies (EMG, EEG, nerve [Neurodiagnostic]
What is your proficiency for each specialty?
GI/GU [GI_GU]
Otolaryngology [Otolaryngology]
General Surgery [General_Surgery]
Cardiology [Cardiology]
Ophthalmology [Ophthalmology]
Neurology [Neurology]
Pulmonology [Pulmonology]
Dermatology [Dermatology]
Neurosurgery [Neurosurgery]
Family Medicine [Family_Medicine]
Allergy/Immunology [Allergy_Immunology]
Plastic Surgery [Plastic_Surgery]
Internal Medicine [Internal_Medicine]
Infectious Disease [Infectious_Disease]
Oncology [Oncology]
Orthopedics [Orthopedics]
Hematology [Hematology]
OB/GYN [OB_GYN]
Podiatry [Podiatry]
Radiology/Oncology [Radiology_Oncology]
Psychiatry [Psychiatry]
Pain Mgmt/Anesth [Pain_Mgmt]
Pediatrics [Pediatrics]
Are you proficient with accents?
Asian [Asian]
Middle Eastern [Middle_Eastern]
Hispanic [Hispanic]
Indian [Indian]
Fast Dictators [Fast_Dictators]
Favorites [favorites]
Dislikes [dislikes]