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Application for Faculty Employment

By clicking submitting your application, you attest that the statements that you have made in this application are true to the best of your knowledge and belief.

First Name
Middle Initial
Last Name
Address Line 1
Address Line 2
City
State
Zip
Day Phone
Evening Phone (if different)
Email Address
Are you licensed to practice Optometry
If so, in which states?
Are you licensed to use pharmaceutical agents for therapeutic purposes?
Optometry School (if applicable) Name
Optometry School Location
Optometry School Dates of Attendance
Graduate School (if applicable) Name
Graduate School Location
Graduate School Dates of Attendance
Graduate School Degree (highest terminal degree)
Undergraduate School #1 Name
Undergraduate School #1 Location
Undergraduate School #1 Dates of Attendance
Undergraduate School #1 Degree or Number of Units Earned
Undergraduate School #2 Name
Undergraduate School #2 Location
Undergraduate School #2 Dates of Attendance
Undergraduate School #2 Degree or Number of Units Earned
What was your optometry school GPA at the time of graduation?
Please attach your curriculum vitae
Have you been convicted of an offense other than traffic violations?
Please answer the simple math question below to submit the form.
2 + 2 =