Join Our Team – Advocate Insurance Billing

Today's Date*

Your Full Name*

First Middle Last

Your Cell Phone*

Your Email*

Your Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Date of Birth*

Sex

Male
Female

Marital Status*

Married
Single
Other

Are you currently employed?

Do you currently have a job?

Yes
No

If hired, will you be quitting your other job?

Do you have a business that you own?*

Yes
No

Do you think your business will interfere with your work/time for us?

If not, why do you think that? Explain.

Job Experience*

Please give us a brief description of your job experience and skills.

How many hours are you willing to work per week?*

Do you have a criminal record?*

We reserve the right to do a background check on all new hires.

Yes
No

If yes, please explain.

Do you have any health problems that might affect your ability to do your job?*

Yes
No

If yes, please explain.

Please give us 3 references concerning your reputation and character.

One should be a personal reference (family member or close friend) and the other two should be professional/character references (people that you have worked with or worked for, pastor/religious leader that knows you).

Personal Reference Name*

First Middle Last

Personal Reference Email*

Personal Reference Phone*

What is your relationship with this person?*

Father, sister, friend, etc.?

Professional/Character Reference Name*

First Middle Last

Professional/Character Reference Email*

Professional/Character Reference Phone*

What is the nature of your relationship with this person?*

Are they a co-worker or boss? Is this a pastor/religious leader that knows you?

Professional/Character Reference Name*

First Middle Last

Professional/Character Reference Email*

Professional/Character Reference Phone*

What is the nature of your relationship with this person?*

Are they a co-worker or boss? Is this a pastor/religious leader that knows you?

Do you have a fairly new computer (less than 3 years old)?*

Yes
No
I will be purchasing a new computer soon.

Do you have Windows 10 Pro on your computer?*

Yes
No
I will be installing/upgrading to Windows 10 Pro soon.

Do you have a smartphone less than 3 years old?*

Yes
No
I will be purchasing a new smartphone soon.

Do you have a high quality headset?*

This will be used for making phone calls, zoom.com meetings, recording training videos, etc.

Yes
No
I will be purchasing one soon.

Do you have dependable, fast internet service?*

Yes
No
I will be acquiring the service soon.

Do you have cybersecurity software installed on your computer?*

This type of software protects your computer form viruses, ransomware, malware, and more.

Yes
No
I will be purchasing the software soon.

I understand that if hired, there is a 90 days probation period.*

During the 90 days, we evaluate your work ethic and performance. If you meet our standard, you will then remain employed with us indefinitely.

Yes
No

Government Issued ID*

Please upload a clear picture of your government Issued ID, preferably a Driver's License (front and back).

Drop files here or

Any additional comments?