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Welcome to Precision Medical Group!

In order to continue with your onboarding process, the documentation and information below is required.

Please do NOT close, refresh, or back out of this page. This form is HIPAA encrypted and will remove all sensitive data.

Name(Required)

First Last

DOB(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please upload a copy of:

One from List A

Upload 1 from each other list(One from List B and One from List C) for a total of 2 documents.

Option 1: List A

Please provide only one (1) document from this list.

List A Includes:

U.S. Passport or U.S. Passport Card
Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
Employment Authorization Document that contains a photograph (Form I-766)
Foreign passport with form I-94 or Form I-94A with Arrival-Departure Record, and containing an endorsement to work
Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI.

Documents that Establish Both Identity and Employment Authorization

Max. file size: 2 GB.

Uploaded documents will be scanned for viruses before submission. All document handling is HIPAA compliant and encrypted for your security.

Failure to submit forms will count as an incomplete application and will be rejected.

Option 2: List B and C

Please provide one (1) document from List B and one (1) document from List C.

List B Includes:

Driver's license or ID card issued by a State or outlying possession of the United States provided in contains a photograph or information such as name, date of birth, sex, height, eye color, and address
ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address
School ID card with a photograph
Voter's registration card
U.S. Military card or draft record
Military dependent's ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Driver's license issued by a Canadian government authority

List C Documents

U.S. Social Security Card
Certification of report of birth issued by the Department of the State (Forms DS-1350, FS-545, FS-240)
Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal
Native American tribal document
U.S. Citizen ID Card (Form I-197)
Identification Card for Use of Resident Citizen in the United States (Form I-179)
Employment authorization document issued by the Department of Homeland Security (DHS)

Documents that Establish Employment Authorization

Drop files here or

Max. file size: 2 GB.

Uploaded documents will be scanned for viruses before submission. All document handling is HIPAA compliant and encrypted for your security.

Failure to submit forms will count as an incomplete application and will be rejected.

General Application Info

Do you require visa sponsorship now or in the future?(Required)

Yes

Position applying for(Required)

Are you fluent in any other language besides English?(Required)

Yes

Please list your fluent language(s)

If referred, please provide the employee's name/relation.

Confirmation

I certify that the information provided is true and complete to the best of my knowledge. I understand that providing false information may be grounds for rejection or termination.(Required)

Precision Medical Group