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EMPLOYMENT APPLICATION

Carolinas Pain Center, PLLC. provides equal employment opportunity to all qualified persons, and does not unlawfully discriminate against any
person on the basis of race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, or any other
legally protected status.

Please –
• Complete all items on the application, even if the information is included on your resume or other document submitted by
you.
• Sign and date your application.
• Specify the exact title of the position in which you are interested.
• Type or print all requested information.
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  • Personal Information

  • General Information

  • (if yes, verification will be required)
  • Employment Request

  • Employment History

    *Please begin with most recent employment
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  • Education

  • Military

  • References

  • Resume Upload

    Please use button below to attach your resume. (pdf format)
  • Drop files here or
    Max. file size: 256 MB.
    • Signature/Certification

      I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for rejection of my application or, if I am employed by this company, for my immediate termination from employment. I authorize Carolinas Pain Center, PLLC. to make any necessary inquiries and investigations into my education, military, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to Carolinas Pain Center, PLLC by any of the schools, services, or employers listed on this application.
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