Employment Application Please enable JavaScript in your browser to complete this form. - Step 1 of 4Welcome Letter *I read thisEssential Therapy Services INC thanks you for taking an interest in our SLP, SLPA OT, COTA, PT, PTA position. Our company recruits highly motivated individuals with a strong passion for their chosen field. We are actively searching for professionals who are seeking to provide the best possible service to their patients and join our fast-growing team. This position entails providing direct and indirect speech and language services to adults and children. Emphasis/expertise should be in the area of autism-spectrum disorders, cerebral Palsy, multiple system atrophy, voice disorders. You will be responsible for the initial and continuous evaluation, reevaluation, development, and implementation of a plan of care. You will submit treatment reports in a timely manner. You will educate and counsel patients and families regarding treatment plans and progress. Provides information regarding appropriate selection/use of adaptive equipment and support resources. You will assist with all services necessary for the treatment, including, but not limited to various methods of aiding patients with feeding. You will also plan and/or assists with patient discharge from therapy services. If the description provided is aligned with your interests and your professional objectives, we would like to extend a formal invitation to fill this Application, where we can further discuss this position. If we determine you are the right candidate for the position, we will ask that you complete our employment application and applicable paperwork, as well as provide the required documents necessary to work in home health. We look forward to meeting you. Respectfully, NextFull Name *PhoneDate of Birth *Social Security *Driver License Number *Marital StatusMarriedSingleWidowedSeparatedDivorcedCivil PartnerEmail *GenderMaleFemaleNon-binaryPrefer not to sayOtherAddress *Address Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHave you ever been convicted of a crime? *NoYesExplain why you were convictedDo you able to permit a Background check? *NoYesI agree the company may rely this authorization to order background reports, including investigate consumer reports, from companies other than the Background Check Company without asking me for my authorization again as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of the personal information I provided is true and correctExplain why we can not run a background checkNextLast Employer Name # 1Company Name 1 *Position 1 *From:MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920To:MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Supervisor Name *PhoneLast Employer Name # 2Company Name 2 *Position 2 *From:MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920To:MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Supervisor Name *PhonePreviousNextSocial Media ProfilesFacebook ProfileLinkedin ProfileInstagram ProfileTwitter ProfileTiktokResume * Click or drag files to this area to upload. 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