Front Office Specialist

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Education

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Start date year

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Are you eligible to work in the U.S.?
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Have you obtained a High School Diploma or GED?
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What is your desired compensation for this role? *

Do you currently hold any of these certifications/licenses? Please check all that apply. If not, please select NONE. *

None

National Contact Lens Examiners (NCLE)

American Board of Opticianry (ABO)

Licensed Dispensing Optician (LDO)

Certified Ophthalmic Assistant (COA)

Certified Ophthalmic Technician (COT)

Certified Surgical Technologist (CST)

Ophthalmic Scribe Certification (OSC)

Certified Paraoptometric (CPO)

Certified Occupational Therapy Assistant (COTA)

Have you ever been terminated from employment or asked to resign by an employer?
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If yes, please provide company name and details. *

Can you work any shift?
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Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?
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Were you referred by a current employee?
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If referred by a current employee, what is their full name? *

If you accept employment with our company, will you live or work in the state of IL?
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To the best of your knowledge, have you ever worked for our company or affiliated companies?
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Eye Care Partners and it's affiliated companies are an equal opportunity employer. Eye Care Partners does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Eye Care Partners to hire me. If I am hired, I understand that either Eye Care Partners or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Eye Care Partners has the authority to make any assurance to the contrary.

I attest with my typed signature below that I have given to Eye Care Partners true and complete information on this application. No requested information has been concealed. I authorize Eye Care Partners to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Signature: *

I attest that I am not an “Ineligible Person” and that I understand that I must immediately disclose to Eye Care Partners any debarment, exclusion, or suspension. Ineligible Persons includes an individual or entity who is currently excluded, debarred, suspended, or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or non procurement programs; or has been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a‐7(a), but has not yet been excluded, debarred, or suspended.

Signature: *

For government reporting purposes, we ask candidates to respond to the below self-identification survey.

Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Clarkson Eyecare’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.

As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness…