West Palm Beach
•
Gardens/Jupiter
Make an Appointment
Tap Here To Send A Text
Text: (561) 500-2020
menu
Text
or
Home
Our Team
David Mittleman, M.D.
Elon Luzon, O.D.
Justina Vasiliauskas, O.D.
Cassandra Onofrey, M.D.
Steven Edens, M.D.
Jackson Goldberg, M.D.
Louis Michaelos, D.O.
Pierce Deibele, O.D.
Stephanie Cuellar, O.D.
Marcus Erickson, O.D.
Our Services
Advanced Cataract Lenses/LaserAssisted Surgery
IV-Free Cataract Surgery
Laser Eye Surgery
LASIK
Refractive Lens Exchange
EVO ICL
Comprehensive Eye Care/ Exams
Glaucoma Treatment
Cornea & Retina
Cornea
Retina
Optical Shop
Oculoplastics
Diabetic Retinopathy Treatment
Eye Floater Treatment
Fuch’s Dystrophy
Refractive Laser Eye Surgery
Selective Laser Trabeculoplasty (SLT)
Ultra-Widefield Retinal Imaging
Resources
Patient Info
Awards
Blog
Testimonials
Locations
West Palm Beach
West Palm Beach Office Tour
Jupiter
Jupiter Office Tour
Surgery Centers
Careers
Refer a Patient
Home
Our Team
David Mittleman, M.D.
Elon Luzon, O.D.
Justina Vasiliauskas, O.D.
Cassandra Onofrey, M.D.
Steven Edens, M.D.
Jackson Goldberg, M.D.
Louis Michaelos, D.O.
Pierce Deibele, O.D.
Stephanie Cuellar, O.D.
Marcus Erickson, O.D.
Our Services
Advanced Cataract Lenses/LaserAssisted Surgery
IV-Free Cataract Surgery
Laser Eye Surgery
LASIK
Refractive Lens Exchange
EVO ICL
Comprehensive Eye Care/ Exams
Glaucoma Treatment
Cornea & Retina
Cornea
Retina
Optical Shop
Oculoplastics
Diabetic Retinopathy Treatment
Eye Floater Treatment
Fuch’s Dystrophy
Refractive Laser Eye Surgery
Selective Laser Trabeculoplasty (SLT)
Ultra-Widefield Retinal Imaging
Resources
Patient Info
Awards
Blog
Testimonials
Locations
West Palm Beach
West Palm Beach Office Tour
Jupiter
Jupiter Office Tour
Surgery Centers
Careers
Refer a Patient
Tap To View Our Locations
Close panel
West Palm Beach
Tap To View Map
call us
Jupiter
Tap To View Map
call us
Explore Our Practice
Resources
Patient Portal
Meet Our Doctors
Emergency Contact
Contact Us
Fax (561) 478-1300
A
A
A
Click here to resize type
Jupiter
Schedule an Appointment
Please ensure Javascript is enabled for purposes of
website accessibility
Employment Application Form
"
*
" indicates required fields
First Name
*
Last Name
*
Date
MM slash DD slash YYYY
Street Address
City
State
Zip Code
Phone
*
Email
*
Date Available
MM slash DD slash YYYY
Desired Salary
Position Applying For:
*
- Select -
Administrative/Communications Specialists
Entry Level Clinic Technician
Front Desk Receptionists
HR Manager
Medical Billing Specialist
Sales Associate
Do you speak any other languages?
*
How did you hear about us?
*
Are you a citizen of the United States?
Yes
No
If no, are you authorized to work in the U.S.?
Yes
No
Have you ever worked for this company?
Yes
No
If yes, when?
Have you ever been convicted of a felony?
Yes
No
If yes, explain:
Education
High School:
Address:
Total Years Attended:
Did you graduate?
Yes
No
Diploma:
College:
Address:
Total Years Attended:
Did you graduate?
Yes
No
Degree:
Other:
Address:
Total Years Attended:
Did you graduate?
Yes
No
Degree:
References
Full Name:
Relationship:
Company:
Phone
Full Name:
Relationship:
Company:
Phone
Full Name:
Relationship:
Company:
Phone
Previous Employment
Employment 1
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving:
May we contact your previous supervisor for a reference?
Yes
No
Employment 2
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
Employment 3
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
May We Use This Number To Send Text Messages That Pertain To Your Job Application?
*
Yes
No
Would You Like To Be Considered For Other Positions Now Or In The Future?
*
Yes
No
Why Should Mittleman Eye Hire You?
*
Can You Provide An Example Of Working In A Fast-Paced Environment That Includes Multitasking?
*
On A Scale Of 1-10, What Is Your Computer Skill Level?
*
1
2
3
4
5
6
7
8
9
10
What Experience Do You Have Using Multiple Programs At Once?
*
Upload Resume
*
Drop files here or
Select files
Max. file size: 12 MB.
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.
I also undertsand that if I'm offered employment, that my employment would be at will. This means your employment would be for an indefinite period of time and would be subject to termination by you or us, with or without cause, with or without notice, and at any time.
By your signature below, you acknowledge your understanding that your employment with Mittleman Eye is at will, and that nothing in this handbook is intended to constitute a contract of employment, express or implied.
Print Full name
*
Date
MM slash DD slash YYYY
Consent
I agree to the privacy policy.
Email
This field is for validation purposes and should be left unchanged.
CLOSE