ITS Job Application Form

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Integrated Therapy Solutions LLC provides equal employment opportunity to all qualified persons, and does not unlawfully discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Complete all items on the application, even if the information is included on your resume or other document submitted by you.
Application Date *

Month Day Year
Full Name *

First Name Last Name
E-mail
Do you have a valid driver's license? *

YES NO
Driver's License (State/No.)
Professional State License (State/No.)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Day Time Phone *

Area Code Phone Number
Position Applying for *
Referred By (If Applicable)

First Name Last Name
Are You Legally Eligible to Work in the U.S.? *

Yes No
Are you willing to take a drug test? *

Yes No
How Many Hours Do You Want to Work Per Week? *

0-10 10-20 20-30 30-40 40+
What Days Are You Available to Work?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Desired Start Date

Month Day Year
Date
Minimum Salary or Hourly Requested
WORK HISTORY / EXPERIENCE

Please list your most current work history/experience
Employer's Name (Most current) *
Position Held *
Telephone *

Area Code Phone Number
Supervisor's Name *
Reason for Departure *
Duties *
Start Date *

Month Day Year
End Date *

Month Day Year
May we contact this employer? (please check one) *

YES NO
If NO, reason why not
(2) Employer's Name
Position Held
Telephone

Area Code Phone Number
Supervisor's Name
Reason for Departure
Duties
Start Date

Month Day Year
End Date

Month Day Year
May we contact this employer? (please check one)

YES NO
If NO, reason why not
Provide Up to 3 PROFESSIONAL References from past/current supervisors only.
Reference (1) Name *
Reference (1) Telephone *

Area Code Phone Number
Relationship to Reference.
Email
Reference (2) Name *
Reference (2) Telephone *

Area Code Phone Number
Relationship to Reference.
Email
Reference (3) Name *
Reference (3) Telephone *

Area Code Phone Number
Relationship to Reference.
Email
Education:

Please list your most relevant education/ degree obtained
School Name
Degree/License Obtained
Years of Attendance
Year Started - Year Graduated
School Name
Degree/ License Obtained
Years of Attendance
Year Started - Year Graduated
Do you have any other experience, training, qualifications or skills which you feel make you especially suited to work at IntegratedTherapy Solutions? If so, please explain.
Why do you want to join ITS Integrated Therapy Solutions?
Do you speak, write or understand any foreign languages?
List any addition languages spoken and written
Upload Your Resume
Upload Your CV
How did you hear about this position?
Disclaimer and Signature

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired.I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to re-quest and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.I also acknowledge that my employment may be terminated, or any offer or acceptance of employment with-drawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.
Signature

Clear
Type Name *
Date

Month Day Year
Date
Should be Empty:

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WORK HISTORY / EXPERIENCE

Provide Up to 3 PROFESSIONAL References from past/current supervisors only.

Education:

Disclaimer and Signature