OSF Saint Francis Medical Center

Peoria, Illinois

Skype Interview Preference Sheet

The below form must be completed by all applicants. Print and include as a supplemental form in your DICAS application.

Please choose three of the following dates and times that you will be available. We will notify you by telephone or e-mail to confirm your schedule one-week prior to the interview. Please check three choices as listed below and indicate 1=first choice, 2=second choice and 3=third choice. We can not guarantee that your will get your first choice, but we will try to accommodate your needs.

Please Select your 1st, 2nd and 3rd options for interview times. All times shown in Central Standard Time.

First Choice Second Choice Third Choice

Name _______________________________________________________________________

Address ______________________________________________________________________

Email Address _________________________________________________________________

City ___________________________________________________________________________

State _________________________________________________________________________

Zip Code ______________________________________________________________________

Skype Username ______________________________________________________________

Signature of Applicant __________________________________________________________

Date ____________________________________________________________________________