OTA The Koomar Center Team Member Application

OTA The Koomar Center

Clinical Team Member Application
Are you ready to help children thrive?

We are excited to start this process with you!

Complete this application below, and we will be in touch soon.

Have a question?

Email careers@otathekoomarcenter.com.
Full Name*

First NameMiddle NameLast Name
Phone Number*
Email Address*
example@example.com
How did you hear about OTA The Koomar Center?*

FriendWebsiteSocial MediaOther
What about OTA The Koomar Center prompted you to apply?*
Which clinical position are you apply for?

Occupational TherapistSpeech Language PathologistMental Health CounselorOther
What are your goals for this position?*
How do you desire to grow in your first year at OTA The Koomar Center?*
What expectations do you have for your leader, supervisor or mentor?*
Who is your ideal client?*
In a team environment, what role do you typically take on?*
We love games and toys! What is your favorite to use in therapy?*
If you had $100, how would you spend it on YOU (not therapy!)?*
We make learning fun! What is the nerdiest thing you do in your spare time outside of work? *
What is your preferred setting? Check all that apply. *

Schools (Public, Private, Charter)ClinicOther
What is your preferred work schedule?*

Full-TimePart-timePRN
Are you available to work after school hours?*

YesNo
Are you available to work on Saturdays?*

YesNo

Professional References*

	Full Name	Email Address	Phone Number	Relationship	Location
Former/Current Supervisor Reference
Reference
Reference

OTA The Koomar Center