Employment Application

Sections To Complete

Target Location (city and state you would prefer to practice)

State*

City*

Available Start Date*

Current Physical Address (required for NPDB background check)*

Mailing Address (if different from above)

What personal ties do you have to your target location?*You have 500 characters left out of 500

Work Availability

1. Every Vohra physician’s practice is customized to the minimum number of hours and volume each is interested in managing, but we require that all physicians dedicate a minimum of 3 weekdays or 25 hours per week to the practice. What is your preferred time commitment?*You have 500 characters left out of 500

2. Will you have other work obligations outside of Vohra if you join our practice? If yes, please explain:*You have 500 characters left out of 500

3. Vohra works on a fee-for-service model to fairly compensate physicians and allow flexible working hours dictated by the physician. The average compensation per patient encounter is $60. Physicians see four patients per hour on average. There is a ramp up period of approximately three months. Do you have any questions about this fee-for-service model?*

4. What is your annual/hourly compensation goal with your Vohra practice?*

5. How many miles/how much time would you be comfortable driving on an average day?*

6. Our training program is three weeks long and includes both virtual and hands-on training with a Vohra physician in your area. Are there any obligations/restrictions that would impact your ability to train contiguously for three weeks with us?*You have 500 characters left out of 500

7. Are you bound by a non-compete agreement with your current/past employer? If yes, please explain. We would also request that you share your non-compete agreement.* You have 500 characters left out of 500

Non-compete Agreement File

Credentialing

Please provide complete and accurate information as facilities perform extensive background checks on each physician that visits. Emergence of undisclosed information during the credentialing process creates embarrassment for all parties and ends in rejection by the facility.

Have you ever been arrested or charged with a violation of any local, state, or federal law?*

Yes No

Describe any past/pending criminal convictions.You have 500 characters left out of 500

Are you aware of any investigation, inquiry, review, or other board proceeding in which you were a party of interest? (This includes any state agency, medical board, hospital, payor, facility, or government).*You have 500 characters left out of 500

Describe any past/pending disciplinary action/restriction in relation to Medicare, Medicaid, or another payor.*You have 500 characters left out of 500

Describe any past/pending actions against your Medical License/DEA/Hospital privileges.*You have 500 characters left out of 500

References

Referral Name 1*

Referral E-mail 1*

Referral Name 2*

Referral E-mail 2*

Referral Name 3*

Referral E-mail 3*

I authorize the company to perform a background check and contact my references.*

Sections To Complete

Applicant Information

Target Location (city and state you would prefer to practice)

Work Availability

Credentialing

References