Planned Parenthood Association of Utah - Medical Provider

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Full name✱
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Current location
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Current company

Links

LinkedIn URL

Hours

What is your ideal number of hours desired?

Please provide 3 references, providing full name and phone numbers

Reference 1✱
Reference 2✱
Reference 3✱

Prescreen Interview -

You may occasionally be scheduled to work at another clinic. Are you ok with that?✱
- Yes
- No
Which health center locations would you be willing to travel to, if needed?✱
- Ogden
- Metro
- Salt Lake
- West Valley
- South Jordan
- Utah Valley
- N/A
What is the minimum number of hours per week you are willing to work in a part-time capacity?✱
What is your ideal number of hours desired?✱
Notes/Comments

Additional information

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.

Gender

Race

Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino)
A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above five races.

Demographic Survey

What is your location?

Demographic Survey for Planned Parenthood Association of Utah

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.

What is your age range?
- 17 or younger
- 18-20
- 21-29
- 30-39
- 40-49
- 50-59
- 60 or older
I identify my ethnicity as
Select all that apply
- White / Caucasian
- Hispanic, Latino, or Spanish origin
- Black or African American
- Asian
- Native Hawaiian or other Pacific Islander
- Indigenous Peoples, First Nations, Native American, or Alaska Native
- Middle Eastern or North African
- Some other race, ethnicity, or origin
What gender do you identify as?
- Female
- Male
- Non-binary

Medical Provider - ARPN or PA