Join Our Team Step 1 of 4 25% Thank you for considering Eye Country for employment. At Eye Country, we offer the most comprehensive eye care and technological advancements in the industry. We strive for excellence. We can only be as excellent as our employees are. Therefore, we do set high standards for our employees. Below are brief descriptions of the positions within Eye Country. Front Desk Specialist: Our Front Desk specialist is the core of the team. Our Front Desk Specialist is responsible for making the patient feel welcomed and valued. Often times he/she is the first and the last person the patient comes into contact with during their visit to our office. It is important that they leave feeling great about the choice they have made to trust us with their eye care. Your main duties would be checking patients in when they arrive, discussing expected out of pocket fees upon arrival, answering telephone, scheduling appointments and maintaining our patient schedule, reminder and confirmation calls and other various administrative tasks. Insurance/Billing Specialist: The Insurance & Billing Specialist’s main duty will be verification of benefits, filing insurance claims, communication with the patient and their insurance company as needed. In addition, this teammate will be responsible for maintaining working knowledge of all participating insurance plans in order to effectively process accurate payment posting to the patient’s account. Clinical Technician/Contact Lens Technician: Our Technicians perform a wide variety of duties including conducting diagnostic tests, recording and measuring vision, testing eye function, instructing patients in inserting and caring for contact lenses, preparing examination rooms, cleaning equipment and scribing for Dr. Oosterbaan in the exam room. Optician/Frame Stylist: Our Optician/Frame Stylist advises patients on various types of lenses and spectacle frames, including advice on style, weight and color. They advise patients on how to wear and care for their eyeglasses. You would be taking frame and facial measurements to ensure correct fit and positioning. Adjusting and repairing eyeglass frames. You would be responsible for selecting, managing and ordering a range of optical products, arranging and maintaining frame displays, liaising with sales representatives from vision care product supplies. Qualifications for all of these positions are listed below. We are willing to train the right individual if you have the following qualities: Willingness to learn Proficiency with computers and other office equipment Organization and prioritization skills Attention to detail Commitment to excellent patient care Fast paced environment Multitasking Compassion Interpersonal and Communication Skills Regular and punctual attendance If you feel like you could be the right person for the job, please complete the application. After reviewing your application, if we feel you could be a good match for our team, we will email you to set up an interview. Thank you for considering Eye Country! Employment Application for Eye CountryPlease complete to the best of your ability. “Yes” answers or the answers we “want” to hear are not necessary for the job - only your honesty. Date Date Format: MM slash DD slash YYYY Name First Last Present Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Permanent Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best phone number to reach you?May we leave a message?YesNoEmail address: How did you find out about this position?Have you applied for a job with us in the past?YesNoIf so, how long ago?Do you have the legal right to work in the US?YesNoOn a restricted basis?During the past 5 years, have you been convicted of, or have you pleaded guilty or no contest to, a felony offense?YesNoIf yes, please explain:Do you have any experience working a medical office?YesNoIf yes, please explain:Do you have any experience working in retail or sales?YesNoIf yes, please explain:Do you have any experience working in the Optometric/Ophthalmology/Optical Field?YesNoIf yes, please explain:How much time have you lost at work over the last year due to inability to come (such as sick, emergencies etc)?Please specify the exact times you are available to work on the following days:MonTuesWedThursFriSatHow many Saturdays per month are you willing to work?How many late days (until 7 pm) are you willing to work a week?Are there any specific days where you would not be able to work late evening?Please indicate the amount of hours per week that you would be most happy with:How soon would you be able to start?Please rank the following job positions in order of which most interest you, the one on the top being of most interest to you, the one on the bottom being of least interest to you. See above description of each position for detail.Front Desk SpecialistInsurance/Billing SpecialistClinical/Contact Lens TechnicianOptician/Frame StylistDo you have any special requests or circumstances that you would like us to consider working around?(days you can’t work, time you can’t work, medical conditions that may keep you from being able to perform duties, etc.)Why do you want this job?Why do you feel I should I hire you?Explain your goals for the next five years:What do you think it takes to be a successful employee?What was the worst job you ever had and why?What accomplishments are you most proud of?Do you work better with a team or as an individual, and explain why?What are your hobbies?List your priorities in lifeDescribe your organization skillsPlease briefly tell me about yourself.How would you describe your computer skills?How would you describe your typing skills?How many words per minute do you type on average?What are your strong points?What are your weak points? Please list your five most recent employers. Start with your present or last job. Please complete even if you have provided a resume to us. 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AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth 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BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number:Supervisor:Date Employed: From: To: Reason for Leaving:Did you give at least a two week notice?YesNoIf not, please explain:Hourly RateSalary Starting Final Work Performed:May we contact this employer?YesNoEmployer:Job Title:Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number:Supervisor:Date Employed: From: To: Reason for Leaving:Did you give at least a two week notice?YesNoIf not, please explain:Hourly RateSalary Starting Final Work Performed:May we contact this employer?YesNoPlease explain any time gaps in between jobs listed aboveHave you ever been involuntarily terminated from a position of employment?YesNoIf so, please explain I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment, and I understand that any wrong or incomplete information on the form may disqualify me for further consideration for employment or, if discovered after I am hired, may be grounds for my immediate dismissal. I understand that all such information is subject to verification by Eye Country, and hereby give my consent to Eye Country to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo any type of drug and/or alcohol testing that Eye Country may require at any time. Finally, I understand that submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and either I or Eye Country may terminate my employment at any time, with or without notice or reasonApplicant Signature:Date: Date Format: MM slash DD slash YYYY Email Email