Allied Health Interview Form

 

Note: The information you provide and submit will be sent directly to the Staff Recruitment department. It will not be shared with any other party and kept in the strictest of confidence. 

****WE ARE NOT ACCEPTING CANDIDATES OUTSIDE OF THE UNITED STATES AT THIS TIME****

If you prefer not to fill out the on-line questionnaire at this time, but would like Michelle to contact you directly, please do not hesitate to submit an email inquiry or email message with your resume attached. E-mail Michelle

First Name:  
Last Name:  
Address:
City, State, ZIP:
Email Address:  
Primary Phone Number:  
Secondary Phone Number:  
How did you hear about Medi-Sota or find this website?
The discipline of healthcare that I am involved in is:
I am a:
I am a:
Location Requirements:



 		 Willing to relocate from
     current address
 Not willing to relocate
 Willing to commute miles
     from current address
Please note primary reason actively seeking employment:
 
I am a current student. Please indicate in box a Y or N for yes or no:





 		 Are you willing to relocate?
Are you willing to accept a position
     offered less than full-time?
Are you willing and available to be
     scheduled ‘on call’ for emergencies
     on a rotating basis?
Are you willing and available to work
     weekend shifts on a rotating basis?
My timeframe situation to accept employment is such that:











 		 I am able to accept an offer immediately
     and give my 2 week notice immediately
I am able to accept an offer immediately
     but need to give more than a 2 week
     notice
I am graduating from a program in the
     future and available to start employment
     by month/year
I am not immediately looking to make an
     employment change but will be more
     ready to make a move in X months/years
I am not in any particular timeframe to
     accept an offer and give notice to my
     current employer
My professional certifications include:


 		 List:
I am currently working on this certification:  
From what school/program did you graduate?



 		 A 2-year program from
    
A 4-year program from
    
A Master’s program from
    
A Doctorate program from
    
A certificate or less than 2 year program
     from
I did not complete any particular
     program
Are you registered in the state of MN for your area of healthcare discipline?




 		 Yes, my license is valid and current
     with the state of MN
No, because I have not worked in
     the state of MN to date
Not yet but I am eligible to obtain
     licensure in the near future
I have previously held a MN license
     but it is not currently valid
Does your current employer know that you are actively seeking new employment?







 		 Note: Confidentiality in the search process is extremely important to us
Yes, my current employer is very
     aware of my search
Yes, but only a select few in the
     organization are aware
No, my search process is very
     confidential
I am not currently employed
Does not apply because I am a
     current student
What stage of your search and interview process are you in?











 		 I am in the initial stages and this is
     the first contact I have made
I am in the initial stages and have
     several applications out but no
     interviews
I am currently interviewing for at least
     one or more positions
I have been searching for a while now
     but only applying to a select few
I have at least one or more job offers
     currently on the table but have not
     accepted employment yet
I have turned down at least one or more
     offers within the last 6 months
 

NOTE: This information will be submitted directly to our Staff Recruiting Department.  You will be contacted via telephone or email if we are currently recruiting for a position in your area of healthcare discipline.  If we are not recruiting in your area of expertise currently, we will keep your information in our database for at least 6 months.  You are encouraged to visit our website periodically for an updated listing of openings.

 
Corporate Office
Deb Ranallo, Director
320-769-2269
Email Deb		 Physician Recruiter
Mark Roisen
888-311-1193
Email Mark 		Staff Recruiter
Michelle Falling
866-793-8409
Email Michelle		 Education Coordinator
Carol Gerlach
320-564-5015
Email Carol