Employment Application
Master Eye Associates is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below.


Applicant Information
Full Name
Email
Phone #
Street Address
City
State
Zip Code


Are you 18 years of age or older?


Describe yourself

Please do not put See Resume.
Please fill out all this information to be considered

Employment Position
How did you hear about this position?


Will you consent to a mandatory controlled substance test?


Have you ever applied to or worked for Master Eye Associates before?


If yes, when?
Do you have any condition which would require job accommodations?


If yes, please describe accommodations required.
If hired, can you provide verification of your legal right to work in the U.S?


Have you ever been convicted of, or received deferred adjudication for a felony?
If YES, provide the nature of the offense, and your age at the time of the offense:



Placement Information
Can you work at any of our locations?
If No, which locations?


Minimum Salary Expected
$ per
When could you start?
If needed, are you available to work overtime?


Do you have reliable transportation to and from work?
Availability:
  Full-Time
  Part-Time
  Weekends

Days Available:

Must be able to work any hours between 9am to 6pm. Closed Sundays
  Monday
  Tuesday
  Wednesday
  Thursday
  Friday
  Saturday
  Any

Job Skills / Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Master Eye Associates complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. )

Education and Training
Are you currently a student or plan to be a student while working?
Select the highest grade completed:
High School
Name
Location (City, State)
Year Graduated
College/University
Name
Location (City, State)
Year Graduated
Degree Earned
Vocational / Specialized Training
Name
Location (City, State)
Year Graduated
Degree Earned

Military
Are you a member of the Armed Services?


What military skills do you possess that would be an asset for this position?

Previous Employment
Employer Name
Job Title
Supervisor Name
City,State, and Zip Code
Employer Telephone
Dates Employed
Reason for leaving
Start Salary
End Salary
May we contact for a reference


Employer Name
Job Title
Supervisor Name
City,State, and Zip Code
Employer Telephone
Dates Employed
Reason for leaving
Start Salary
End Salary
May we contact for a reference


Employer Name
Job Title
Supervisor Name
City,State, and Zip Code
Employer Telephone
Dates Employed
Reason for leaving
Start Salary
End Salary
May we contact for a reference



References
Please provide personal and professional reference(s)
Reference #1
Contact Information #1
Reference #2
Contact Information #2
Reference #3
Contact Information #3

AT-WILL EMPLOYMENT
The relationship between you and the Master Eye Associates is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Master Eye Associates. No representative of Master Eye Associates has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Signature (type your name)



- 5 Convenient Locations -
Olive Branch
Poplar Commons
Southaven
Winchester
Master Eye Associates - Olive Branch 5218 Goodman Rd Olive Branch, MS 38654 Phone: Coming Soon
Master Eye Associates - Poplar Commons Poplar Commons 4562 Poplar Ave #115 Memphis, TN 38117 Phone: (901) 683-1796 Fax: (901) 683-1603
Master Eye Associates - Southaven 338 Goodman Rd W Southaven, MS 38671 Phone: (662) 510-7397 Fax: 9662) 598-4280
Master Eye Associates - Winchester 7706 Winchester Rd. #105 Memphis, TN 38125 Phone: (901) 752-1551 Fax: (901) 752-1505
Master Eye Associates - Wolfcreek 2825 N. Germantown Parkway #103 Memphis, TN 38133 Phone: (901) 384-9259 Fax: (901) 385-7592

Master Eye Associates proudly serves Memphis, TN and the surrounding areas of Cordova, Collierville, Southaven, Bartlett, Germantown, Olive Branch, Byhalia, Horn lake and West Memphis.

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