Online Employment Application | Florida Therapy Services

ONLINE EMPLOYMENT APPLICATION

Please answer all applicable questions. Résumés are not accepted in lieu of completion of this application.

Position Applying For: *

Clinic Location *

Name *

First

Last

Street Address *

Please enter your home address here. This is a required field.

City/State/Zip *

Please enter the city, state, and zip code for your home address. This is a required field.

Phone Number *

Email (required) *

Confirm Email

How did you hear about the position?

FTS Website
Social Media
Job Board
Existing Staff Member

If referred by social media, job board, or staff member, indicate name/site below:

Have you ever been convicted of, pled guilty, no contest, or nolo contendere to a crime? *

Have you ever been charged with a crime and either been placed on court-ordered probation, had adjudication withheld, or entered a pre-trial intervention program? *

If yes, to either of the above questions as to crimes, give details as to the type of crime, the date of conviction and penalty impose. A conviction will not necessarily disqualify you from employment.

What was your highest level of education? *

List the following: School Name, City/State, # of Years, Degree, Major Course of Study. *

Please list all schools in chronological order from most recent onward.

Are you a Certified Targeted Case Manager, a Certified Medical Assistant, or a Certified Nursing Assistant? *

If you answered YES, please provide your certificate number in the next section under Other Skills.

Other Skills: List any other job-related skills or qualifications that support your application.

EMPLOYMENT EXPERIENCE:

List all jobs for the past seven (7) years with the most recent job listed first. Account for all time periods including unemployment, self-employment, and military service.

Job #1: Start Date & End Date *

Please start with most recent job.

Job Title *

Summarize the Nature of Work Performed and Job Responsibilities *

Employer, Complete Address, and Phone Number *

Immediate Supervisor and Title *

Hourly Rate/Salary *

Reason for Leaving *

Job #2: Start Date & End Date

2. Job Title

2. Summarize the Nature of Work Performed and Job Responsibilities

2. Employer, Complete Address, and Phone Number

2. Immediate Supervisor and Title

2. Hourly Rate/Salary

2. Reason for Leaving

Job #3: Start Date & End Date

3. Job Title

3. Summarize the Nature of Work Performed and Job Responsibilities

3. Employer, Complete Address, and Phone Number

3. Immediate Supervisor and Title

3. Hourly Rate/Salary

3. Reason for Leaving

To provide additional employment history, please list the information below:

Please include Start/End Dates; Job Title; Employer Name, Address, and Phone Number; Immediate Supervisor Name and Title; Hourly Rate/Salary, and Brief Job Description.

Provide an explanation for all gaps in employment history.

Please include From/To dates and a brief explanation.

In order to check your work and educational records, should we be made aware of any changes of name or assumed names that you previously used? *

If Yes, please identify the names:

Have you ever been employed here before? *

If Yes, please identify dates:

Do you have reliable transportation to work? *

Will you work overtime, if asked? *

Are there any hours, shifts or days you will not work? *

If yes, please explain:

Date available for work: *

Do you currently possess the required documents to work in the U.S.? *

Proof will be required upon employment.

If you are available, what other locations would you be interested working?

You may select multiple locations.

Do you have any friends or relatives who work here? *

Full Name & Relationship:

CHARACTER REFERENCES

List three persons, not related to you, whom you have known at least one year. Providing an email address is Required.

1. Name *

First

Last

1. Relationship *

1. Phone Number *

1. Email (required) *

Confirm Email

2. Name *

First

Last

2. Relationship *

2. Phone Number *

2. Email (required) *

Confirm Email

3. Name *

First

Last

3. Relationship *

3. Phone Number *

3. Email (required) *

Confirm Email

List any other information or remarks that you wish to have considered, as part of your application for employment.

APPLICANT’S STATEMENT (Select each statement to indicate agreement or approval.)

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that misrepresentations, omissions of facts or incomplete information provided in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts in this application will be cause for dismissal at any time without any prior notice.
I authorize the investigation of all matters contained in this application and hereby give Florida Therapy Services, Inc. permission to contact schools, previous employers, references, and others as required by governing agencies. I hereby release Florida Therapy Services, Inc. from any liability as a result of such contact.
I understand that while Florida Therapy Services, Inc. makes every effort to provide steady, continuous work, I am not guaranteed the permanence of any position. I understand that my employment with Florida Therapy Services, Inc. is for no specific term and may be terminated by me or Florida Therapy Services, Inc. with or without notice or cause at any time. I further understand that no oral promise, Florida Therapy Services, Inc. policy, custom, business practice or other procedure constitutes an employment contract or modification of the at-will employment relationship between me and Florida Therapy Services, Inc.
I understand that I will be required to undergo a background screening and receive clearance through the following agencies: Fingerprinting (FDLE and FBI), Agency for Health Care Administration, state and local law enforcement. Failure to pass these screenings could result in immediate termination.
The contents of Florida Therapy Services, Inc. employee handbook, personnel manuals, as well as other policies and practices, are subject to change or modification by Florida Therapy Services, Inc. solely at its discretion, without notice. I also understand that no supervisor or other official of Florida Therapy Services, Inc. (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

Signature & Date *

By typing my name, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Name