Join Our Team

Career & Professional Interest Form

Help us learn about your experience, interests, and availability for our remote and hybrid telehealth team.

This form collects interest for potential opportunities. Submission does not guarantee an interview, employment, or a contract.

1

Contact Information

2

Roles of Interest

Select all that apply. *

3

Professional Licensure

Do you hold an active state professional license? *

Where are you currently licensed? (Select all that apply)

4

Experience & Contribution

Which best describes your telehealth experience? *

Use this space as your cover letter. Share your strengths, relevant experience, career goals, and how you would support safe patient care, teamwork, and access through telehealth.

5

Professional Organizations & Training

Are you involved in organizations related to any of the following? Select all that apply.

6

Preferred Working Arrangement

Select all that apply. *

The company subcontracting option applies only to applicants who hold an active state professional license. Working arrangements depend on the role and applicable classification requirements.

7

Schedule & Availability

Schedule type — select all that apply. *

Work setting preference *

Scheduling options depend on role requirements and coverage needs.

8

Résumé Upload

PDF, DOC, or DOCX — maximum 10 MB. Please exclude Social Security numbers, financial information, and patient information.

9

Additional Comments

Fields marked with an asterisk (*) are required.