Audit & Coding Experts

* Last Name:	* First Name: MI:
* Address:	Apt / Unit:
* City:	* State: * Zip:
Home Phone:	Cell Phone:
* Email:

TIMES AVAILABLE TO WORK
MondayTuesdayWednesdayThursdayFridaySaturday Sunday

WORK PREFERENCES
Full TimePart Time Remote Only

Are you a citizen of the United States? Yes No
If No, are you authorized to work in the U.S.? Yes No

Please List:

High School:	From: To: (i.e. 01/2009)
Address:
Did you graduate? YesNo Degree:
College:	From: To: (i.e. 01/2009)
Address:
Did you graduate? YesNo Degree:

Inpatient:
ED'S:
Ambulatory Surgery:
Clinics:
E & M:
Infusion:
Pathology:
Interventional Radiology:

Attach Resume Here: (.doc, .pdf, .txt formats)

Enter Resume Here:

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 and misleading information in my application or interview may result in termination.

Date: 05/21/2012