Career Applications

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First name*

Last name*

Email*

Phone*

Address*

Position*

Preferred Start Date

Month

Day

Year

Desired hours*

Full Time

Part Time

PRN

Preferred Schedule (check all that apply)*

Mornings

Afternoons

Evenings

Weekdays

Weekends

Regular/Consistent

Flexible/Variable

Short Term

Long Term

What type of benefits and/or compensation are you seeking?*

Please specify monetary compensation, as well as other desired benefits.

Resume*

Please include work history, education history, applicable licensures and skill certifications, contact information for your current/last supervisor, and a minimum of two references.

May we contact your current employer?*

Yes

N/A

For your last three places of employment, please list your reasons for leaving the position.*

For your last/current place of employment, please list your starting salary or hourly wage.

For your last/current place of employment, please list your current or ending salary or hourly wage.

Are you authorized to work in the U.S. on an unrestricted basis?*

Yes

Able to work with restrictions

Have you ever been charged with or convicted of a felony? If yes, please explain:*

Convictions will not necessarily disqualify an applicant for employment.

Have you ever been sued for or charged with medical malpractice, negligence, insurance fraud, falsification of documentation, or privacy violations? If yes, please explain:*

Pending litigation, and/or past charges will not necessarily disqualify an applicant from employment.

Do you consent to a drug screen if you are hired?*

Yes

Our company is a drug free workplace. This includes utilization of recreational marijuana. We have a zero-tolerance policy for drug utilization not protected in and disclosed to the Ohio Safe Harbor program for healthcare providers seeking treatment for substance abuse disorders.

Optional Disclosure: Do you have any disabilities you would like to disclose? (Disclosures will not necessarily disqualify applicants from employment. We are willing to make reasonable accommodations for disabilities whenever possible.)

If you have specific accommodations, you want to request, especially in needed during a potential interview, feel free to include them here.

Link to CV/LinkedIn

Call

419-969-3608

info@allytotalpt.com

If you have questions, please feel free to contact our office. We'll do our best to answer your questions and let you know if we can help with your specific condition.

Thanks for submitting!