Online Application Form
Thank you for considering Orthopaedic Rehab Specialists for employment
About this application
Please answer all questions. Resumes are not a substitute for a completed application. ORS is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws. This company is an at will employer as allowed by applicable state law that means that regardless of any provision in this application, if hired, the company or I may terminate the employment relationship at any time, for any reason, with or without cause or notice.
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Position applied for:
FT Front Desk Receptionist - Holt
PT Front Desk Receptionist - Holt
FT Front Desk Receptionist- West Ciinic (Jackson)
FT Physical Therapist- Holt
Name
First Name
Middle Name
Last Name
Do you have an alias: Maiden name, former name (if applicable)
First Name
Last Name
Phone Number
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Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
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How long have you lived at this address?
(# of years/months)
If under the age of 18, can you produce the necessary work certificate at the time of employment?
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Type of employment desired:
Full Time
Part Time
Specify number of hours per week:
Desired Salary?
Our work schedules often require flexibility. Please mark the times that you are able to work when needed:
6am-9am
9am-12pm
1pm-4pm
4pm-7pm
After 7pm
Are you able to work overtime?
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No
Have you previously applied for employment with this company?
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No
If yes, when and where did you apply?
Have you ever been employed by this company?
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If yes, please provide dates of employment, location and reason for separation from employment:
Education:
Please give your education history
Name of High School:
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What year did you graduate?
Please list any honors or extracurricular activities:
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What year did you graduate?
What level of degree did you finish:
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Please list any honors or extracurricular activities:
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Name of Graduate or Trade School
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Work Experience
Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach any additional sheets if needed. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Please do not respond "See Resume".
Employment History:
Please include information from your 2 most recent jobs:
Name of most recent employer:
Address
Street Address
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State / Province
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Area Code
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Date you started employment there:
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Date
Still employed there?
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If applicable, date you ended employment there?
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Job Title:
Duties and responsibilities:
Supervisors Name:
May we contact:
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No
If not, why not: (Please give a brief description):
Please give starting wage:
Please give ending wage:
Reason for leaving?:
What would your employer say was the reason for your termination?:
Were you ever disciplined by this employer?:
Yes
No
If yes, for what reason: (Please explain briefly):
How much notice did you give when resigning? If none, please explain briefly:
Employer (2nd most recent job)
Please give us information from your 2nd most recent employer
Name of 2nd most recent employer:
Address
Street Address
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City
State / Province
Postal / Zip Code
Phone Number
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Area Code
Phone Number
Date you started employment there:
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Month
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Day
Year
Date
Still employed there?
Yes
No
If applicable, date you ended employment there?
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Month
-
Day
Year
Date
Job Title:
Duties and responsibilities:
Supervisors Name:
May we contact:
Yes
No
If not, why not: (Please give a brief explanation):
Please give starting wage:
Please give ending wage:
Reason for leaving?:
What would your employer say was the reason for termination?:
Were you ever disciplined by this employer?:
Yes
No
If yes, for what reason: (Please explain briefly):
How much notice did you give when resigning? If none, please explain briefly:
Have you ever been terminated or asked to resign from any job?
Yes
No
If yes, how many times?
If yes, what was the reason for the resignation?
Has your employment ever been terminated by mutual agreement?
Yes
No
If yes, how many times?:
If yes, what was the mutual agreement:
Have you ever been given the choice to resign or be terminated?
Yes
No
If yes, how many times?
If yes, what was the reason you chose to resign?
List 2 Professional References:
Please list 2 professional work-related references we may contact. Individuals with no previous work related experience may list school or volunteer-related references:
Name of Professional Reference #1
Name of Company and Address
Title/Position
Phone Number
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Area Code
Phone Number
Email
example@example.com
Working Relationship with you (Supervisor/Co-Worker)
Name of Professional Reference #2
Name of Company and Address
Title/Position
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Working Relationship with you (Supervisor/Co-Worker)
Personal References:
Please list the names of personal references (not previous employer or relatives) who you know that we may contact:
Name of Personal Reference #1:
Their occupation/company/address:
Years known:
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Name of Personal Reference #2:
Their occupation/company/address:
Years known:
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Final Steps: Attach your resume and cover letter
Please attach your resume: (PDF form please)
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Attach Cover Letter for Physical Therapist job and address it to: Amy Chamberlain, Director of Administration and Sports Medicine, 206 Page Ave., Jackson, MI 49201
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Attach Cover Letter for Front Desk Receptionist jobs and address it to: Marcy Shephard, Office Manager, 206 Page Ave. Jackson, MI 49201
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Employment Agreement:
EMPLOYMENT AGREEMENT: I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state and local law. If the Company has such a program and i am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal state and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law. If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement. I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment o, if employed, disciplinary action, up to and including immediate dismissal. AT-WILL EMPLOYMENT: This company is an at-will employer as allowed by applicable state law. This means that regardless of any provision in this application, if hired, the company or I may terminate the employment relationship at any time, for any reason, with or without cause or notice. Nothing in this application or in any document or statement, oral or written, shall limit the right to terminate employment at-will. No officer, employee or representative of the company is authorized to enter into an agreement - express or implied- with me or any applicant for employment for a specified period of time unless such an agreement is in a written contract signed by the president of the company. If hired, I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will. I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state, or local law,. If applicable and allowed by law, I will receive separate written notification regarding the Company's intent to obtain "consumer reports". I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charge, or causes of action which I may have asa a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize the company to provide truthful information concerning my employment to future employers and hold the company harmless for providing such information. If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand that this Company employs only individuals who are legally eligible to work in the United States. THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST RE-APPLY. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THIS APPLICATION:
Electronic Signature - By putting your name in this box, you are agreeing to the contents of the information submitted with this application.
Date of application:
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Minor Consent Application-If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and thte applicant's legal guardian.
Date of application:
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If you want to mail in your application, click Print Form below:
Then, print out your application, resume and cover letter and mail them to: Employment Manager, 206 Page Ave., Jackson, MI 49201 c/o Employment Application
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