| First Name |
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| Middle Name |
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| Last Name |
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Possible start date
(mm-dd-yyyy) |
-
-
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Licenses you have
|
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Licenses in progress
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City and State you are located in
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Teleradiology experience
|
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Are you currently setup to receive and view images at home?
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Any malpractice claims against you?
|
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| Are you seeking full-time or part-time position? |
|
| List number of hours with preferred timings you would like to
work for |
|
| Approximate volume of prelim studies you could read over a
given period (i.e.. per hour, or day) |
|
| Phone number and best time of day for a continued discussion
|
|
| Describe your ideal teleradiology position
|
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| Please include an updated copy of your resume
|
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| |
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