Physician Assistant / Nurse Practitioner

San Mateo, CA
Advanced Practice Clinicians – Primary Care /
Full-Time /
On-site

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Gender Diversity

  • If your pronouns are not listed above, please enter them below if you would like.

Work Eligibility

  • Are you 18 years of age or over?
  • Are you legally eligible to work in the U.S.?
  • Will you now or in the future require visa sponsorship for employment?
  • If you require sponsorship either now or in the future, please explain your situation.
  • Do you have a relative who currently works at Carbon Health Technologies or Direct Urgent Care?
  • If yes, please list their name(s) and relationship to you.
  • Have you ever been excluded from participation in any state or federal health care program?

CA License

  • Do you have an active and unrestricted California license to practice?

Primary Care - NP/PA

  • Do you have an active Board Certification as a NP/PA?
  • Which organization are you Board Certified through?
  • Do you have an active and unrestricted state license as a NP/PA?
  • Which other states do you currently have active and unrestricted licenses to practice?
  • Do you have a controlled substance license along with a DEA license with no restrictions?
  • What states do you have an active DEA license?
  • How many years of post-graduate experience as a NP/PA do you have?
  • Do you have experience in Primary Care or Internal Medicine?
  • How many years of post-graduate experience in Primary Care or Internal Medicine do you have?
  • Which age groups do you have experience seeing?
  • Which days are you available to work?

Background Consent

  • Are you willing to undergo a background check in accordance with local law/regulations?

TCPA Consent & Privacy

  • TCPA Consent & Privacy: Notwithstanding any current or prior election to opt in or opt out of receiving telemarketing calls or SMS messages (including text messages) from us, our agents, representatives, affiliates, or anyone calling on our behalf, you expressly consent to be contacted by us, our agents, representatives, affiliates, or anyone calling on our behalf for any and all purposes arising out of or relating to your application, at any telephone number, or physical or electronic address you provide or at which you may be reached. You agree we may contact you in any way, including SMS messages (including text messages), calls using prerecorded messages or artificial voice, and calls and messages delivered using auto telephone dialing system or an automatic texting system. Automated messages may be played when the telephone is answered, whether by you or someone else. In the event that an agent or representative calls, he or she may also leave a message on your answering machine, voice mail, or send one via text. You consent to receive SMS messages (including text messages), calls and messages (including prerecorded and artificial voice and autodialed) from us, our agents, representatives, affiliates or anyone calling on our behalf at the specific number(s) you have provided to us, or numbers we can reasonably associate with your account (through skip trace, caller ID capture or other means), with information or questions about your application, loan and/or account. You certify, warrant and represent that the telephone numbers that you have provided to us are your contact numbers. You represent that you are permitted to receive calls at each of the telephone numbers you have provided to us. You agree to promptly alert us whenever you stop using a particular telephone number. Your cellular or mobile telephone provider will charge you according to the type of plan you carry. You also agree that we may contact you by e-mail, using any email address you provide.

Credentialing

  • Please provide your legal first, middle and last name that your license is registered under.
  • Medical License Number
  • NPI License Number
  • Did you opt out from Medicare?
  • If yes, what are the dates of your two year opt out period?

U.S. Equal Employment Opportunity information   (Completion is voluntary and will not subject you to adverse treatment)

Our company values diversity. To ensure that we comply with reporting requirements and to learn more about how we can increase diversity in our candidate pool, we invite you to voluntarily provide demographic information in a confidential survey at the end of this application. Providing this information is optional. It will not be accessible or used in the hiring process, and has no effect on your opportunity for employment.


Demographic Survey for Carbon Health Technologies

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

  • I identify my ethnicity as:

    Select One:

  • Indicate your gender:
  • Voluntary Self-Identification of Disability

    What is a disability? A disability is broadly defined as a long-term physical, mental, intellectual or sensory impairment.