1500 14th St W Ste 100 Williston, ND 58801
(701) 577- EYES (3937)
|
✉
EMAIL US
Office Hours
Request Appointment
Patient Forms
Reorder Contact Lenses
★
Read•Post Reviews!
ABOUT US
WHY CHOOSE US?
OFFICE HOURS
MEET YOUR EYE DOCTORS
★
REVIEWS
INSURANCE
BILLING POLICY
MEDICAL APPOINTMENT NOSHOW
HIPAA
Internal Access Only
Email
Patient Forms
SERVICES
ANNUAL EYE EXAMS
MEDICAL SERVICES
EYEWEAR SERVICES
CONTACT LENSES
COMPUTER VISION
DRY EYE
EYEGLASSES
EYEWEAR COLLECTIONS
BLUE LIGHT LENSES
POLARIZED LENSES
TRANSITION LENSES FAQ's
EYEGLASSES FAQ's
CONTACT LENSES
REORDER CONTACT LENSES
CONTACT LENS TYPES
CONTACT LENS BRANDS
CONTACT LENSES FAQ's
SCLERAL LENSES FAQ's
HOW TO VIDEOS
CHILDRENS VISION
INFANTSEE®
PEDIATRIC EXAM
CHILDREN'S VISION
SPORTS VISION
COMPUTER VISION
EYE LIBRARY
REQUEST APPOINTMENT
PATIENT FORMS
COLOR DEFICIENCY QUIZ
EYE EXAM
EYE LIBRARY
VIDEOS
COMMON PROBLEMS
CATARACT
GLAUCOMA
MACULAR DEGENERATION
DRY EYE
CHILD'S EXAM
GENERAL FAQ's
CARECREDIT
CAREERS
Employment Application
Applicant Information
Position Applied for:
Full Name:
Full Address:
Phone:(xxx) xxx-xxxx
Email:
Date Available:
Social Security No.:
Desired Salary $:
Are you a U.S. Citizen:
Yes
No
If not Citizen, Are you Authorized to work in U.S.:
Yes
No
Have you ever worked for this company:
Yes
No
If worked for this company, when:
Have you ever been convicted of a felony:
Yes
No
If you have been convicted of a felony, explain:
Education
High School Name:
High School Address:
From Date:
To Date:
Did you graduate:
Yes
No
College Name:
College Address:
From Date:
To Date:
Did you graduate:
Yes
No
What Degree:
Other Name:
Other Address:
From Date:
To Date:
Did you graduate:
Yes
No
What Degree:
Professional References
Reference 1 Full Name:
Reference 1 Full Address:
Reference 1 Company:
Reference 1 Phone:(xxx) xxx-xxxx
Reference 1 Relationship:
Reference 2 Full Name:
Reference 2 Full Address:
Reference 2 Company:
Reference 2 Phone: (xxx) xxx-xxxx
Reference 2 Relationship:
Reference 3 Full Name:
Reference 3 Full Address:
Reference 3 Company:
Reference 3 Phone: (xxx) xxx-xxxx
Reference 3 Relationship:
Previous Employment
Company Name:
Company Address:
Company Phone: (xxx) xxx-xxxx
From Date:
To Date:
Supervisor:
May we contact the Supervisor for a reference:
Yes
No
Starting Salary $:
Ending Salary $:
Job Title:
Responsibilities:
Reason for Leaving:
Company Name:
Company Address:
Company Phone: (xxx) xxx-xxxx
From Date:
To Date:
Supervisor:
May we contact the Supervisor for a reference:
Yes
No
Starting Salary $:
Ending Salary $:
Job Title:
Responsibilities:
Reason for Leaving:
Company Name:
Company Address:
Company Phone: (xxx) xxx-xxxx
From Date:
To Date:
Supervisor:
May we contact the Supervisor for a reference:
Yes
No
Starting Salary $:
Ending Salary $:
Job Title:
Responsibilities:
Reason for Leaving:
Military Service
Branch:
From Date:
To Date:
Rank at Discharge:
Type of Discharge:
If other than Honorable Discharge, explain:
Disclaimer and Submit
AGREED
I certify that my answers are true and complete to the best of my knowledge.
AGREED
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
We participate in the following charities
OFFICE HOURS
Mon
8:00 - 5:00
Tue
8:00 - 5:00
Wed
8:00 - 5:00
Thu
8:00 - 5:00
Fri
8:00 - 5:00
Sat
Closed
Sun
Closed
Williston Basin Eyecare
1500 14th St W
Ste 100
Williston, ND 58801
(701) 577- EYES (3937)
Williston Basin Eyecare
1500 14th St W Ste 100
Williston
,
ND
58801
Phone:
(701) 577-3937
Fax:
(701) 577-3938
Williston Basin Eyecare Associates, PC proudly serves Williston, ND and the surrounding areas of Watford City, Zahl, Cartwright, Grassy Butte, Fairfield, Tioga and the Montana areas of Homestead, Fairview, Sidney, Crane, Glasgow, Vida and Wolf Point.
© 2025 All content is the property of
Williston Basin Eyecare
™ & assoc. vendors.
Website Powered and Developed by
EyeVertise.com