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.

     

  • Format: (000) 000-0000.
  • How did you hear about OTA The Koomar Center?*
  • Which clinical position are you apply for?
  • What is your preferred setting? Check all that apply. *
  • What is your preferred work schedule?*
  • Are you available to work after school hours?*
  • Are you available to work on Saturdays?*
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  • Demographic Questions

  • Which of the following best describes your gender?*
  • How would you describe your race/ethnicity?*
  • For government reporting purposes, please indicate if you are a veteran.*
  • (The following question is asked to comply with government regulations. Your response is voluntary.)Do you have a physical or mental disability that substantially limits one or more major life activities?

  • Regulatory Questions

  • Are you legally authorized to work in the United States?
  • Will you now or in the future require sponsorship for employment visa status?
  • If hired, will you be able to provide proof of identity and employment eligibility as required by the federal government?
  • Do you hold any active professional licenses or certifications relevant to this position?
  • Has your licensure ever been revoked or suspended?
  • Has your medical liability insurance ever been denied or cancelled?
  • Have you ever been excluded from participation in Medicare, Medicaid, or any other federally funded healthcare program?
  • Are you familiar with HIPAA regulations and willing to complete training to ensure compliance with patient privacy laws?
  • This position may require a background check and/or drug screening as a condition of employment. Are you willing to comply with these requirements?
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