The Doctor Job: Pain Relief for Your Job Search - Residents, Medical Students and Physicians finding jobs with extensive interview counseling, Resume/CV revisions, and targeted mailings to hospitals, single and multi-specialty practice groups and other medical hiring organizations.

If you are a resident or physician looking for a job with a doctor's office, hospital, or other medical hiring organization, The Doctor Job can help you.

Please fill out this form in its entirety. Failure to fill out this form correctly or completely will invalidate all rights and privileges under the guarantee. Once this form has been filled out, if you are within the eligible time period, you will be contacted regarding your eligibility for a refund under the terms of our guarantee..

First Name:
Last Name:
Email address:
Home Phone:
Cell Phone:

CONTACT INFORMATION AT TIME OF ORIGINAL ORDER:
Address:
City:
State:
Zip Code:

CURRENT CONTACT INFORMATION (if different):
Address:
City:
State:
Zip Code:

Current Employer:
How long have you been employed with this employer? yrs, mos


INFORMATION ABOUT YOUR SECOND, FREE MAILING UNDER THE GUARANTEE:
Date order for second mailing was placed:	,
Date package was received:	,
Date letters were mailed:	,
(if you paid for The Doctor Job to do the mailing, please select the date that you received the folder with the tracking information)

Number of letters mailed:
Number of letters unmailed (if any):
If unmailed letters, please give your specific reasons for not mailing each letter:


Number of undeliverable letters:
Please list, in explicit detail, all responses received, including the name of the person who contacted you, the result of the conversation, and the date of the interview, if any:


Did you receive any offers for employment?
If yes, please give your reasons for not accepting each offer:


In which state(s) were you searching?
Are you licensed in each state?
When did you graduate from your residency or fellowship (whichever was later)?	,
Do you have anything in your background that prevents you from getting an unencumbered medical license in any state in the US?

Has your medical license ever been suspended for any period of time or for any reason?

Please use this space to provide any additional information that can prove helpful in reviewing your case and determining your eligibility under the guarantee:


I attest, under penalties of perjury, that the information and statements that I have provided in this form are true, complete and accurate, and that I understand that providing false, incomplete or inaccurate information will invalidate any rights to which I may otherwise be entitled under the guarantee, and that I have read, understand, and agree to the terms of the guarantee as described online here, and the Terms and Conditions as described online here. Furthermore, I attest, under penalties of perjury, that all letters received in the second mailing were mailed in a timely fashion, except where indicated above. I understand that The Doctor Job has seeded the second mailing with letters that allows them to verify if all letters were indeed mailed, and that failure to mail all letters except as disclosed above will immediately invalidate all rights and privileges under the guarantee.

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