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Applied Health Job Application

Professional Information:

Available Postitions:

Your Specialty:

Years of Experience:

Personal information

First name:

Middle name:

Last name:

Social Security #:

Date of Birth:

Permanent Address

Address:

City:

State:

Zip code:

Current Address

Address:

City:

State:

Zip code:

Will be at this address until:

Contact information

Telephone:

Fax:

Mobile:

Email:

Best Time to Reach You:

Comments:

Additional Information:

How did you hear about Applied Health:

Preferred Geographic Region:

Have you ever applied with us before?

Yes No

If so, when?:

Desired Length of Assignment:

Specialty Preference:

Setting Preference:

Date you can start:

Certifications:

Do you have documeneted legal rights to work in the US?

Yes No

Employment History:

Attach A Resume:

May we contact your current employer?

Yes No

May we contact your previous employers?

Yes No

Most Recent Employer

Name of Organization:

City:

State:

Dates of Employment:

Position Held:

Reason For Leaving:

Was this a Travel Assignment?

Yes No

Which Agency?:

Immediate Supervisor:

Phone number:

Second Most Recent Employer

Name of Organization:

City:

State:

Dates of Employment:

Position Held:

Reason For Leaving:

Was this a Travel Assignment?

Yes No

Which Agency?:

Immediate Supervisor:

Phone number:

Third Most Recent Employer

Name of Organization:

City:

State:

Dates of Employment:

Position Held:

Reason For Leaving:

Was this a Travel Assignment?

Yes No

Which Agency?:

Immediate Supervisor:

Phone number:

Educational Background:

College or University:

City:

State:

Did you graduate?

Yes No

Graduation Year:

Diploma/Degree Earned:

College or University:

City:

State:

Did you graduate?

Yes No

Graduation Year:

Diploma/Degree Earned:

College or University:

City:

State:

Did you graduate?

Yes No

Graduation Year:

Diploma/Degree Earned:

Professional References:

Name 1:

Title:

Phone number:

Name 2:

Title:

Phone number:

Name 3:

Title:

Phone number:

Employment Waiver:

I understand and agree that:

I understand that nothing in the Employment Application creates a contract of employment between me and the Company. If I am hired by the Company, my employment and compensation are “at will,” which means that my employment can be terminated, either by the Company or me, with or without cause, and with or without notice. I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, and that it is an at-will arrangement only.

I understand this application will be active for a period of six months; after that time, if I wish to be considered for employment, I must submit a new application.

I understand that all statements made on this application may be checked by Applied Health. I authorize Applied Health to contact my prior employers and other sources of information, including my background, and I hereby authorize each such employer and source of information to answer any and all questions regarding my prior employment and background. I hereby authorize each such employer and source of information to answer any and all questions regarding my prior employment and background. I hereby agree to indemnify Atlanta Pediatric Therapy, each of my prior employers, and each of the other sources of information contacted, and further agree to hold each and every one of them harmless from any claims arising from this authorization and direction. I also authorize Applied Health to provide truthful information concerning my employment to my future prospective employers and I agree to hold it harmless for providing such information.

I understand that any misstatements or omissions in this application will result in a decision not to hire me, or to discharge me if discovered after I am hired.

Yes No

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News and Events

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Applied Health - June Poetry Project
July 9th, 2010
As you may be aware, we have continued our monthly themes. June was Poetry month. Each day we recited a...

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Applied Health - May Water Challenge
June 16th, 2010
As the temperatures heat up into the 90's, a concern on everybody's mind is hydration. At our Atlanta office, the...

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Atlanta Pediatric Therapy Makes Inc. 5000 List
July 28th, 2009
For the second year in a row, Atlanta Pediatric Therapy, Inc., has made the Inc. 5000 list of the fastest...

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Atlanta Pediatric Therapy Ranked No.15 in Healthcare
July 28th, 2009
Atlanta Pediatric Therapy ranked number 15 in Health care and number 259 for all companies on Inc. Magazine's list of...

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