APPLICATION FOR EMPLOYMENT

For Insurance Billing Specialist

Personal Information

$\backslash$table$[[$Name $($Last$,$ First, Middle$),],[$Area Code$/$Phone Number,$],[$Present Address $($Street$),],[$Present Address $($City$,$ State, Zip$),],[\backslash$table$[[$Are you a US Citizen? If no$,$ type$],[$of Visa, Visa No$/$ Date of Entry.$]],]]$

Employment Information

$\backslash$table$[[$Position you are applying for?,$],[$Full time or part time?,$],[$Date available for employment?,$],[$Wage$/$salary expectation?,$]]$

Professional Licenses and$/$or Certifications

$\backslash$table$[[$Organization or State Issued,Date Issued,Number$],[1.,,],[2.,,],[3.,,]]$

Education

$\backslash$table$[[$School$,$School, Address and Telephone,$\backslash$table$[[$Dates Attended$],[($To$-$From$)]],\backslash$table$[[$Did you$],[$graduate$?]],$Degree$/$Major$],[$High School,,,Yes$/$No$,],[$College$,,,$Yes$/$No$,],[$Graduate Study,,,Yes$/$No$,],[$Other Training,,,,$],[,,,,]]$

$75\%$ Page $299$ of $357.$ Location $6457$ of $8723$