Employment Application - OrthoRehab Physical Therapy

1General

2Availability

3Education

4Employment History

5References

6Resume

7Agreement

Application for Employment

OrthoRehab Physical Therapy, an Equal Opportunity Employer, in accordance with state and federal laws, does not discriminate in hiring, compensation, terms and conditions, or privileges of employment because of an individual's race, creed, color, sex, age, national origin, marital status or disability. OrthoRehab Physical Therapy is committed to selecting the best qualified candidate for available positions.
General
Name*
First Middle Last
Current Address*
Street Address Address Line 2 City State ZIP Code
Current Phone*
Alternate Phone
Have you ever been employed by OrthRehab Physical Therapy?*
- Yes
- No
When?*
Are you legally eligible for employment in the United States?*
(If offered employment, you will be required to provide documentation to verify eligibility)
- Yes
- No

Availability
Position Sought*
Date Available*
MM slash DD slash YYYY
Availablity*
- Full Time
- Part-Time
Number of hours/week available
Target Salary/Wage Range*

Education
Please indicate education or training which you believe qualifies you for the position you are seeking
High School
High School Years Completed*
Diploma*
- Yes
- No
GED*
- Yes
- No
Name of Highschool
City/State
College
College Years Completed*
Diploma*
- Yes
- No
Name of School
City/State
Major
Degree Earned
Other Training/Degrees/Certifications
Name of School
City/State
Course/Major
Degree/Certificate Earned
Professional License or Membership
Type of License(s) held:
Other Professional Memberships:
You do not need to disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status)

References
Name
Address
Phone
Second Reference
Name
Address
Phone
Third Reference
Name
Address
Phone

Resume
Please upload your resume
Resume*
Accepted file types: doc, docx, pdf, Max. file size: 10 MB.

APPLICANT'S CERTIFICATION AND AGREEMENT
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize OrthoRehab Physical Therapy to verify their accuracy and to obtain reference information on my work performance. I hereby release OrthRehab Physical Therapy form any/all liability of whatever kind and nature, which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal in accordance with the policies of OrthRehab Physical Therapy. I acknowledge that OrthoRehab Physical Therapy reserves the right to amend or modify the policies in its Employee Manual and other policies at any time, without prior notice. The policies do not create any promises or contractual obligation between OrthoRehab Physical Therapy and its employees. I understand that should an employment offer be extended to me and accepted, that I will fully adhere to the policies, rules and regulations of OrthoRehab Physical Therapy. However, I understand that neither the policies, rules, regulations of employment, or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration.
Signature*
Date*
MM slash DD slash YYYY
YOUR APPLICATION WILL BE CONSIDERED ACTIVE FOR 30 DAYS FROM DATE INDICATED ON THIS APPLICATION.
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Application for Employment

General

Availability

Education

High School

College

Other Training/Degrees/Certifications

Professional License or Membership

References

Second Reference

Third Reference

Resume