Home Locations Providers Services Careers Patient Portal More… OPEN SEARCH BAR Careers at FPG Medical Assistant - Full time Care Manager - Primary Care Care Coordinator CPC+ Part Time Cleaning & Janitorial - Multiple Buildings Part Time Receptionist Position Medical Front Office Reception Position Physician Assistant/Nurse Practitioner EMPLOYMENT APPLICATION First name * Last name * Address * City * State * Zip code * Phone * Email Are you at least 18 years of age? * Yes No Position you are applying for * Date available * Salary desired * Are you seeking full-time or part-time work? * Full-time Part-time Either Are you available to work Saturdays? * Yes, usually Yes, sometimes No Are you available to work evenings? * Yes, usually Yes, sometimes No EMPLOYMENT HISTORY EMPLOYER #1: Current or most recent employer * Start date * End date * Job title * Ending rate of pay * Employer address * Supervisor * Duties * Reason for leaving * ADD ANOTHER EMPLOYER EDUCATION High School High school name * High school location * Did you graduate high school? * Yes No College College name College location College course of study Did you graduate college? Yes No Still enrolled Other Education School Location Course of study Did you graduate? Yes No Still enrolled SKILLS Professional credentials you hold, including license number and expiration date List computer software with which you are proficient Languages other than English in which you are fluent OTHER EMPLOYMENT QUESTIONS Have you ever been convicted of a criminal offense (felony or misdemeanor)? * Yes No Note: No applicant will be denied employment solely on the grounds of conviction for a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered. Do you have a VALID driver's license? * Yes No REFERENCES Please provide the name, employer and contact information of three persons not related to you with whom you have worked in the past five years. Reference #1 * Reference #2 Reference #3 APPLICANT ATTESTATION By submitting this application I verify that all the information which I have provided on this application and in related materials is true, correct, and complete. I understand that any false, misleading, incomplete, or omitted information will result in rejection of my application, withdrawal of a job offer, or dismissal from employment, whenever discovered. I authorize such information to be used for any decisions relating to my hiring and continued employment. I release any and all persons or companies from any liability or damages for obtaining or releasing information or verifying statements provided by me. I understand that if I am hired by Family Physicians of Greeley, PLLP I must complete a Federal I-9 form and provide verifying documentation of my legal right to reside and work in the United States prior to beginning employment. All candidates who receive an offer of employment will be required to undergo testing for commonly-abused controlled substances. Successful completion of drug screening is a requirement for employment at Family Physicians of Greeley, PLLP. All candidates who receive an offer of employment are subject to a background investigation for social security number verification and criminal history. I agree, if employed, to abide by all Family Physicians of Greeley, PLLP rules and regulations. I understand that such employment is for an indefinite period of time and that Family Physicians of Greeley, PLLP can change wages, benefits and conditions of employment at any time. Family Physicians of Greeley, PLLP is an equal opportunity employer. Qualified applicants will be considered for openings without regard to race, color, religion, sex, age, national origin, veteran status, or disability. Information on this application will not be used to discriminate against any applicant. All offices of Family Physicians of Greeley are non-smoking environments. I have read and understood the above * UPLOAD DOCUMENTS Upload documents such as a resume, cover letter or reference letters. File Upload #1 File Upload #2 File Upload #3 File Upload #4 Submit Application LOCATIONS Central Office 2520 W 16th Street Greeley, CO 80634 (970) 356-2520 Fax: (970) 356-6928 Cottonwood Office 2420 W 16th Street Greeley, CO 80634 (970) 353-7668 Fax: (970) 353-2801 Johnstown Office 473 Castle Pines Avenue Johnstown, CO 80534 (970) 587-7881 Fax: (970) 587-7738 West Office 6801 W 20th Street, Ste 101 Greeley, CO 80634 (970) 378-8000 Fax: (970) 378-8088 Careers Survey Patient Portal Healthwise Home Locations Providers Services Forms Copyright © 2021 Family Physicians of Greeley, PLLPTheme by SiteOrigin