Dual Career Intake form-Vanderbilt University Medical Center

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* 1. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal

Email Address

Phone Number

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* 2. Are you authorized to work in the United States?

Yes

No

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* 3. When are you able to begin employment?

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* 4. Salary Range desired

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* 5. Describe your most current work experience

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* 6. Positions you are suited for:

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* 7. Examples of positions you would consider as alternatives

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* 8. How did you learn about the VUMC Dual Career Program?

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* 9. Where have you already applied?

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* 10. Do you give us permission to share your CV/resume with our employment network?

Yes

No

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* 11. Please attach resume here

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 12. VUMC Employee (or Candidate) Partner Information

Partner Name

Status of Partner: New Hire or Candidate?

VUMC Department

Partner's Job Title

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* 13. Client Agreement: Vanderbilt University Medical Center will provide dual career resources and tools for my job search but is not a placement agency and cannot guarantee employment

Agree

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* 14. Client Agreement: While this is a partnership with the University Medical Center, my job search is ultimately my responsibility

Agree

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* 15. Client Agreement: Dual career recourses and tools can be withdrawn at the discretion of Vanderbilt University Medical Center

Agree