Employment Application

Earheart Healthy Weight Loss, Inc. Winston-Salem, NC – An equal opportunity employer

We are looking for enthusiastic people, who will be involved and committed to the growth of the company. Local, Regional, and even national positions will come from staff that has contributed positively to the growth of the company.

Earheart Healthy Weight Loss is a new patent pending technology for weight loss that is easy, quick and effective. Which means our doctors treat over internet, fax, etc., and use health coaches to treat patients.

The hiring process will include a short phone questionnaire to review your resume and collect any additional information. At times a meeting which includes multiple applicants, and 1 or 2 personal interviews will be conducted. Most questions will be answered during your upcoming meeting and application process.

Employment will start between 2 weeks and 2 months, Salary will be discussed in personal interviews, work hours will vary, but initially may include every other weekend.

Please complete every question to the best of your ability.

First name*
Please type your full name.

Last name*
Please type your last name.

Street address
Invalid Input

Address Line 2
Invalid Input

City
Invalid Input

State / Province / Region
Invalid Input

ZIP / Postal Code
Invalid Input

Country
Invalid Input

Phone*
Please type your Phone number.

Best Time to Call
HH*
Invalid Hours

MM*
Invalid Minutes

Invalid Input
I am insterested in*
This field is required.

Date Available to Start Work*
This field is required.

Are You Over 18 Years Old?
This field is required.

Are You a US Citizen*
This field is required.

Availbe to Work Weekends and/or Evenings?*
This field is required.

Available to Work Over-Time?*
This field is required.

Have You Ever Applied Here Before?*
This field is required.

Do You Have Any Relatives Working for This Company?*
This field is required.

If "Yes" to Above, Name & Relationship of Current Employee(s)
Invalid Input

Primary Method of Transportation to Work?
Invalid Input

Are you able to do the job described with reasonable accommodation?
Invalid Input

If "No", Please describe functions you cannot perform
Invalid Input

This company complies with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants / employees to perform essential functions. It is possible that a employee may be tested on skill / agility, and may be subject to a medical examination conducted by a medical professional.

Have you ever been convicted of or have a pending a felony or misdemeanor?*
This field is required.

If "Yes", Please Explain
Invalid Input

No employee will be denied employment solely on the grounds that a conviction occurred. The information of the offence and surrounding circumstances, may be considered. Not answering truthfully will bar employment or may cause termination.
Education
College/University Name & Address
This field is required.

Did You Earn a Degree?*
This field is required.

Area of Study/Degree*
This field is required.

Number of Years Completed*
This field is required.

High School Name & Address*
This field is required.

Number of Years Completed?
Invalid Input

Did You Graduate?
This field is required.

Other Training: Vocational, Technical, Graduate
Invalid Input

Employment History
Name and Address of Employer
This field is required.

Supervisor Name
This field is required.

Supervisor Phone Number
This field is required.

Start Date
This field is required.

Job Duties & Title
This field is required.

Stop Date
This field is required.

Salary at Start
This field is required.

Salary at Finsih
This field is required.

Why Did/Are You Leaving?
This field is required.

What Did You Like the Best at That Job?
This field is required.

What Did You Like the Least?
This field is required.

Personal Information
What hobbies, goals or other things do you want us to know?
This field is required.

Write a paragraph to describe a problem or situation you experienced with a co-worker or someone you supervised at a previous position, and actions you took to solve it.
This field is required.

Write a paragraph to describe a problem you experienced with a supervisor at a previous position, and actions you took to solve it.
This field is required.

I certify that I have not withheld any information or provided any misstatement of fact on this application or any document provided to secure employment. I understand this would cause immediate expulsion from the company.* Please enter your initials in this field.
This field is required.

I permit the company to examine or investigate references, record of employment education, medical history, or any other information I have provided. I herein authorize any position or reference noted to disclose any information related to my work record or personal experiences, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons or entities from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

I understand that if I am employed, my employment is not defined for a particular term, and can be terminated at any time either with or without prior notice, by either me or the company.
This field is required.

Resume & Cover Letter
You may upload your resume (in PDF format)
Invalid Input