August 20th, 2008
Medical Transcription Sub Contractor Application
Digital Transcription Inc
100 Iverson Street
Greenville, SC 29615-1937
Specialists in the Transcription of
Medical Dictation for over 28 Years
ralphebass@digitran.net
www.digitran.net
864-292-8487
864-268-2587 (Fax)
Medical Transcription Sub Contractor Application
Name: __________________________________________________________ Date: ____________
Last First Middle
Address __________________________________________________________________________
Street City/State Zip
Phone #: ___________________________________ SS #: _________________________________
When can you start? _______________________ Are you bi-lingual? _________________________
Your highest level of education: _______ Where/When: ____________________________________
Are you now employed? ______ Where? ________________________________________________
List last two medical transcription jobs with Name, Phone & Date of employment
Date Superior Company Address Phone Position
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Please Provide Three Personal Recommendations
Name: Phone: Years Known: Relationship
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
I authorize the investigation of all statements in this application.
Date __________________________ Signature: _________________________________________
