Acme Medical Company
Employment Application
Applicant Information
Full Date
Name: Akabueze Chelsea A : 3/24/17
Last First M.I.
Address: 3217 Charleston Ridge
Street Address Apartment/Unit #
Wake Forest NC 27874
City State ZIP Code
Emai
Phone: 919-845-3217 l cakabuezects@gmail.com
Date Social Security Desired
Available: 4/20/17 No.: 924-03-3217 Salary: $ 780,317
Position Applied
for: Congenital Cardiothoracic Surgeon
YE
Are you a citizen of the United YES NO If no, are you authorized to work in the S NO
States? U.S.?
Have you ever worked for this YES NO If yes,
company? when?
Have you ever been convicted of a YES NO
felony?
If yes,
explain:
Education
High Wake Early College of Addres
School: Health and Sciences s: 2901 Holston Ln, Raleigh, NC 27610
Did you YES NO Diplom
From: 1993 To: 1997 graduate? a: Highschool Diploma
Colleg University of North Carolina Addres
e: at Chapel Hill s: 250 E Franklin St, Chapel Hill, NC 27514
Did you YES NO Degree
From: 1997 To: 2001 graduate? : Bachelors of Biology
Other University of North Carolina Addres
: at Chapel Hill s: 250 E Franklin St, Chapel Hill, NC 27514
Did you YES NO Degree
From: To: graduate? :
1
Doctorate of Medicine,
2001 2010 Masters of Surgery
References
Please list three professional references.
Full Relationshi
Name: Nicole Hill p: Professor
Compan
y: Wake Early College of Health and Sciences Phone: 919-555-5555
Address: 2901 Holston Ln, Raleigh, NC 27610
Full Relationshi Supervisor/Profe
Name: Scott McFarland p: ssor
Compan
y: WakeMed Hospital Phone: 919-053-0008
Address: 3000 New Bern Ave, Raleigh, NC 27610
Full Relationshi Supervisor/Profe
Name: Tracy Bowers p: ssor
Compan
y: University of North Carolina at Chapel Hill Phone: 919- 479- 0001
Address: 101 Manning Dr, Chapel Hill, NC 27514
Previous Employment
Compan
y: UNC Hospital Phone: (984) 974-1000
Superviso
Address: 101 Manning Dr, Chapel Hill, NC 27514 r:
Cardiothoracic Surgeon Starting
Job Title: Aid Salary: $ 40,500 Ending Salary: $ 49,800
Responsibiliti Aiding surgeons during procedures and checking up on other patients in
es: cardiac units
March To Reason for Congenital surgical
From: 2005 : April 2010 Leaving: program
May we contact your previous supervisor for a YES NO
reference?
Compan
y: WakeMed Hospital Phone: 1 (919) 350-8000
Superviso
Address: 3000 New Bern Ave, Raleigh, NC 27610 r: Scott McFarland
Starting
Job Title: Cardiothoracic Surgeon Salary: $ 536,762 Ending Salary: $ 642, 501
Responsibiliti Performing surgeries and consulting with patients with cardiothoracic
es: diseases and abnormalities
2
To September Reason for Completion of congenital
From: May 2010 : 2012 Leaving: surgical program
May we contact your previous supervisor for a YES NO
reference?
Compan
y: UNC Hospital Phone: (984) 974-1000
Superviso
Address: 101 Manning Dr, Chapel Hill, NC 27514 r:
Congenital Starting
Job Title: Cardiothoracic Surgeon Salary: $ 765,941 Ending Salary: $ 772,634
Responsibiliti
es: Perform congenital cardiac surgery and general thoracic surgery
October To Reason for
From: 2012 : Present Leaving: Applying to this hospital
May we contact your previous supervisor for a YES NO
reference?
Military Service
Branc
h: N/A From: N/A To: N/A
Rank at Type of
Discharge: N/A Discharge: N/A
If other than honorable,
explain: N/A
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my
application or interview may result in my release.
Signatur Date
e: Chelsea Akabueze : 3/24/17
