AcmeMedicalCompany

Employment Application
Applicant Information
Full Name: Nguyen Jenny H Date: March 24, 2017
Last First M.I.

Address: 1234 Elmer Street

Street Address Apartment/Unit #

Walker SC 47392
City State ZIP Code

Phone: (919) 638-8267 Email Jhnguyen2@gmail.com

Date Available: May 17, 2017 Social Security No.: 6294529352 Desired Salary: $318,000

Position Applied for: Hematology Oncologist

YES NO YES NO
Are you a citizen of the United States? If no, are you authorized to work in the U.S.?

YES NO
Have you ever worked for this company? If yes, when?

YES NO
Have you ever been convicted of a felony?

If yes, explain:

Education
High School: Wake Early College Address: 2901 Holston Ln, Raleigh, NC 27610

YES NO High School Diploma and

From: 2017 To: 2020 Did you graduate? Diploma::Associate's degree in Science

College: East Carolina University Address: E 5th St, Greenville, NC 27858

YES NO
From: 2020 To: 2024 Did you graduate? Degree: Bachelor of Science

University of North Carolina at Chapel

Other: Hill Address: Chapel Hill, NC

YES NO
From: 2024 To: 2028 Did you graduate? Degree: M.D.

1
 References
Please list three professional references.

Full Name: Adam Scott Spencer Relationship: Former employer

Company: Memorial Sloan-Kettering Cancer Center Phone: (212) 639-2000
Address: 839 Daily Hwy, Basking Ridge, NJ 07920

Full Name: Mckinley Anna Grace Relationship: Former employer

Company: The Outer Banks Hospital Phone: (252) 838-7248
Address: 934 Honk Drive, Nags Head, NC 279594

Full Name: Rachel Hanford Traitor Relationship: Co-worker

Company: The Outer Banks Hospital Phone: (252) 839-8282
Address: 732 Olive Hwy, Nags Head, NC 279594

Previous Employment
Company: Memorial Sloan-Kettering Cancer Center Phone: (212) 639-2000
Address: 136 Mountainview Blvd, Basking Ridge, NJ 07920 Supervisor: Adam Scott Spencer

Job Title: Hematology Oncologist Starting Salary:$264,500 Ending Salary: $317,000

Explaining the cancer diagnosis and stage to the patient, discuss the treatment options and the
recommended best course of treatment, compassionate care, and managing cancer-related pain and other
Responsibilities: symptoms/side effects

From: 2036 To: Present Reason for Leaving: Relocation

YES NO
May we contact your previous supervisor for a reference?

Company: The Outer Banks Hospital Phone: (252) 449-4500

Address: 800 S Croatan Hwy, Nags Head, NC 279594 Supervisor: Mckinley Grace

Job Title: Hematology Oncologist Starting Salary:$239,000 Ending Salary: $292,000

Discuss the treatment options and the recommended best course of treatment, compassionate care, and
Responsibilities: managing cancer-related pain and other symptoms/side effects

From: 2034 To: 2036 Reason for Leaving: Company went out of business

YES NO
May we contact your previous supervisor for a reference?

2
Company: Sister Caritas Cancer Center Phone: (413) 748-9230
Address: Mercy Medical Center, 227 Carew St, Springfield, MA 01104 Supervisor: Candice Hendrick

Job Title: Hematology Oncologist Starting Salary:$217,000 Ending Salary: $278,000

Explaining the cancer diagnosis and stage to the patient, discuss the treatment options and the
recommended best course of treatment, compassionate care, and managing cancer-related pain and other
Responsibilities: symptoms/side effects

From: 2032 To: 2034 Reason for Leaving: Relocation

YES NO
May we contact your previous supervisor for a reference?

Military Service
Branch: From: To:

Rank at Discharge: Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may
result in my release.

Signature: JennyNguyen Date : March24,2017