EP Employment Introduction Form


This is an introductory form only.   It is not intended to take the place of a regular Employment Application or Resume.  Its purpose is to let managers that we work with know that you are available. They will then contact you. Due to our confidentiality agreements, you will not know which facilities receive this information. It is possible there are no hospitals that we work with in the area that you are inquiring about. You are therefore encouraged to complete a full job search, as this is only a supplemental tool. We do hope it will be of assistance. If you have a current resume, you may email that to us in place of this form. Fields with an * are required.
 
Today’s Date: Date of Relocation:
Seeking Relocation to Region or City:
Current Lab:
EP Lab only EP / Cath Lab EP / Implant Implant / Cath Lab
Name*:
Address*:
City*:
State*:
ZIP*:
Telephone Number*:
Email Address*:
Last Two Positions & Dates worked*:
Degree / Certifications*:
Current type of procedures you are doing*:
EP Computers:
Stimulator:
Imaging Systems:
Mapping Systems:
Ablation Generator-
EP Catheters-
Implant Experience:
Programming:
Other:
Personal Attributes:



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