Joining our Team

Welcome to the Medtack team. You have chosen to participate as a member of our Patient Enrollment team. To allow for smooth processing, please complete this form.

Enrollment Center Processing Form

Your Personal Information

Your Name

Prefix First Middle Last

Your Email Address

Enter Email Confirm Email

Address

Street Address Address Line 2 City State ZIP Code

Your Phone

Are you legally authorized to work in the United States(Required)

Yes

Have you ever been convicted of a felony?(Required)

Yes

Availability

Type of position you are applying for(Required)

Full-time

Part-time/ Contract

Earliest Start Date(Required)

Given your commitments what's the earliest date you can start?

Estimated Hours You Are Available for Work(Required)

Please tell us what hours you are available for work each day of the week.based on estimation when first starting the position.

Monday

Tuesday

Wednesday

Thursday

Friday

Any additional comments regarding availability

References

Your References

If you have not worked with us before please add at least two references or written references email to managers@credentpartners.com

Name

Title

Cellphone

More About You

Tell Us About Yourself(Required)

Tell us a little about yourself, how you believe you are suited for this role, and your motivation.

Paperwork

Please go to https://www.irs.gov/pub/irs-pdf/fw9.pdf and download and complete a W9 form and email to managers@credentpartners.com