Patient Service Representative

What is your desired compensation for this role? *

Are you at least 18 years or older? (If no, you may be required to provide work authorization to work.) *

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? *

If referred by a current employee, what is their full name? *

To the best of your knowledge, have you ever worked for our company or affiliated companies? *

EyeCare Partners and it's affiliated companies are an equal opportunity employer. EyeCare Partners does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for EyeCare Partners to hire me.

If I am hired, I understand that either EyeCare Partners or I can terminate my employment at any time and for any reason, with or without cause and without prior notice.

I understand that no representative of EyeCare Partners has the authority to make any assurance to the contrary. I attest with my typed signature below that I have given to EyeCare Partners true and