Important: If you select "Online" testing, after submitting your application form, please use your browser's back button and return to this page. Then click Online WAV Testing to download the WAV files for the transcribing portion of your application.
(* indicates required - please fill in form as completely as possible)
* First Name:
* Last Name:
* Address:
* City:
* State/Province:
* Zip/PostalCode:
Phone:
(* home)
(other)
(night)
Fax:
* Email:
SS#/SI#:
Referred By:
Hardware
Do You Currently Own?
Yes
No
IBM-Compatible Computer
Macintosh
Modem (14.4 baud minimum)
Cable/Satellite/Other
Wave Pedal
Email and Internet
Software
Do you currently own?
Yes
No
Windows 95/98/2000/XP/NT
Word Perfect 9.0 or 10.0
WordPerfect 5.1 (DOS)
Word 2000
or 2002
Stedman’s Electronic Spellchecker
Stedman’s Electronic Medical Dictionary
Reference Books You Currently Have (please list)
Please check "Yes" or "No"
Yes
No
If hired, would you be willing to obtain references recommended by Medical Linguistics?
Medical Transcription Experience
Please check "Yes" for all the areas in which you have transcription experience.
Yes
No
Allergy/Immunology
Cardiology
Dermatology
Family Practice
Endocrinology
Gastroenterology
Internal
Medicine
Nephrology
Neurology
OB/GYN
Oncology
Opthamology
Orthopedics
Pathology
Pediatrics
Physical Therapy
Plastic Surgery
Podiatry
Psychiatry
Radiology
Surgery
Urology
References: Acute-care hospital medical records transcription
Names
Locations
Dates Employed
Physician office, clinic, or specialty transcription.
Names
Locations
Dates Employed
Medical Specialty
Number of years experience with each type of report.