APC EMERGENCY MEDICINE INPUT FORM Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.APP Emergency Medicine Input Form Please fill out the form below completely. All fields are required. Thank you for your interest in Lexington Clinic Emergency Medicine! LayoutFull Name (First, Middle Initial, Last) *Please enter your years of experience as a PA-C or APRN Please enter years of service at TeamHealth *LayoutWork Location Preference #1 *CHI Saint Joseph HospitalCHI Saint Joseph Hospital EastFlaget Memorial Hospital in BardstownCHI Saint Joseph Hospital JessamineCHI Saint Joseph Hospital BereaCHI Saint Joseph Hospital LondonCHI Saint Joseph Hospital Mount SterlingPlease enter the number of shifts preferred at location preference #1 *Desired number of hours per shift at location preference #1 *Work Location Preference #2 *CHI Saint Joseph HospitalCHI Saint Joseph Hospital EastFlaget Memorial Hospital in BardstownCHI Saint Joseph Hospital JessamineCHI Saint Joseph Hospital BereaCHI Saint Joseph Hospital LondonCHI Saint Joseph Hospital Mount SterlingPlease enter the number of shifts preferred at location preference #2 *Desired number of hours per shift at location preference #2 *Work Location Preference #3 *CHI Saint Joseph HospitalCHI Saint Joseph Hospital EastFlaget Memorial Hospital in BardstownCHI Saint Joseph Hospital JessamineCHI Saint Joseph Hospital BereaCHI Saint Joseph Hospital LondonCHI Saint Joseph Hospital Mount SterlingPlease enter the number of shifts preferred at location preference #3 *Desired number of hours per shift at location preference #3 *Other Information0 of 300 max characters.Submit
