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479 Old Union Turnpike
Lancaster, MA 01523
1-800-325-3937

100 Powder Mill Road
Acton, MA 01720
978-897-7212

74 Main Street
Gardner, MA 01440
978-632-3930

D'Ambrosio Eye Care Careers

D'Ambrosio Eye Care welcomes inquiries and applications for many exciting eye care practice clinical and administrative positions. We are always looking for energetic staff members who enjoy working as part of a dedicated team of professionals in a fast paced and friendly environment.

The following are examples of positions that are sometimes available:

Ophthalmic Technicians
Billing Specialist
Front Desk Staff
Optician
Optometrist

We are an equal opportunity employer dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disabilities or national origin. Consistent with the Americans with Disabilities Act, applicants may request accommodation needed to participate in the application process.

PERSONAL INFORMATION

Full Name :

E-mail :

Phone:

Over 18?

Yes

Street Address:

City, State, Zip:

Referred By:

EMPLOYMENT DESIRED: select one

Position

Date You
Can Start

Salary Desired

Are you Employed Now?

	Y
	N

If So May We Inquire of
Your Present Employer?

	Y
	N

Ever Applied to this
Company Before?

	Y
	N

Where?

When?

EDUCATION

Name and Location of School

Last Year Completed

Graduate?

Subjects Studied
and Degree(s) Received

Grammar School

High School

College

Trade, Business or Correspondence School

GENERAL

Subjects of Special Study or Research Work

Job Related Skills

FORMER EMPLOYERS
List your last four employers, starting with the last one first.

EMPLOYERS #1

Date Month/Year

From:To:

Company Name

Supervisor Name

Supervisor Phone

Position

Salary

Reason for Leaving

EMPLOYERS #2

Date Month/Year

From:To:

Company Name

Supervisor Name

Supervisor Phone

Position

Salary

Reason for Leaving

EMPLOYERS #3

Date Month/Year

From:To:

Company Name

Supervisor Name

Supervisor Phone

Position

Salary

Reason for Leaving

REFERENCES
List Below three persons not related to you, whom you have known at least one year.

Name
Phone
Position
Years Acquainted
Type of Reference	personal professional

Name
Phone
Position
Years Acquainted
Type of Reference	personal professional

Name
Phone
Position
Years Acquainted
Type of Reference	personal professional

ADDITIONAL INFORMATION

AUTHORIZATION

If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

I understand that any employment is conditioned on the background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employees and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any Interview, is intended to create an employment contract, I further understand and agree that if I am hired, my employment will be "at will" and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies and procedures, in whole or in part, at any time.

I have read and agree with this authorization.