Ro - Virtual Physician (1099 Contractor)

Virtual Physician (1099 Contractor)

New York, NY or Remote

Providers /

Freelance /

Remote

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Full name✱
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Email✱
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Current company ✱

Work Authorization

Are you currently authorized to work lawfully in the United States? Do you now or in the future require visa sponsorship to continue working in the United States?✱

Provider State License

What state licenses do you currently hold? Please check all that apply.✱
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- Washington D.C.
- West Virginia
- Wisconsin
- Wyoming

Comp Expectations (optional)

What is your expected compensation range?

How did you hear about us?

How did you hear about this job posting?

Board Certification

Are you board certified?✱
- Yes
- No
- Pending

Telemedicine Experience

Do you have telemedicine experience?✱
- Yes
- No

Legal Name

Please provide your legal first and last name.✱

Billing

If hired, would you contract as an individual or through an LLC/Corp? What is the name of the LLC/Corp?✱

Approved Board Certifications (MD)

Which are you board certified in?✱
- Internal Medicine
- Family Medicine
- Emergency Medicine
- Other
If other, please explain

Physician Type

Type of Physician✱
- MD
- DO
- Other

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.

Veteran status