JOB APPLICATION

To submit an on-line job application, follow the instructions:

1. Indicate the Job you are applying for (click on the appropriate box - Research Assistant or Clinical Research Coordinator).



2. Complete the Job Application below.



3. Submit the application.



4. Within 7 days of your submission, you will receive an e-mail response from PRN.

Please Fill Out The Application Below:

Check one:   Research Assistant Clinical Research Coordinator

Personal Data:

First Name: MI: Last Name: Address: Telephone: Fax: E-Mail:

Education and Training:

High School: Diploma and Date: Name and Address of College: Degree and Date: Graduate School: Degree and Date: Certification (License):

Experience:

1. Job Description: Job Duties: Name of Supervisor: Telephone:

2. Job Description: Job Duties: Name of Supervisor: Telephone:

3. Job Description: Job Duties: Name of Supervisor: Telephone:

References:

1. Name: Telephone: 2. Name: Telephone: 3. Name: Telephone:

Declaration:

All the information provided above by me is accurate. I will provide the certified copies of my diplomas, certificates and licenses at the time of interview for employment. Name: Date: