To schedule an appointment for interview on a posted position, kindly complete this form and hit submit. VITAL AMBULATORY HEALTHCARE, INC. 10103 FONDREN, SUITE 330 HOUSTON, TEXAS 77096 PHONE: (713) 270-6995 FAX: (713) 270-0334 (OFFICE HOURS: 9:00 AM TO 5:30PM, MON-FRI.) Today’s Date: Applicant’s Name: Home Phone Number: Cell Phone: Pager or other: POSITION POSTED: Do you have experience for this position ? Yes No Years of Experience: Date of Interview desired: Time of Interview desired: Vital Ambulatory Healthcare, Inc. will, upon review of submitted intent to interview for a posted position shall contact prospective applicants using the phone numbers provided on this form. This is not an official application for the company. All Applicants must complete the agency’s official application for employment at the agency’s office prior to the interview. Completion of this form and an invitation for interview does not constitute extension of employment.