• AAA PT EMPLOYMENT APPLICATION

  • Personal Information: 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have the legal right to work in USA? (If yes, verification will be required)*
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -
  •  -
  • Gender

  • Job Interest: 

  • Are you seeking
  • Date Available
     - -
    2 digit month, 2 digit day, 4 digit year
  • Shift Available

  • Days Available
  • Date of Application
     - -
    2 digit month, 2 digit day, 4 digit year
  • Will you consider split shift work?
  • Is this your first time applying for employment with us?
  • Have you ever been convicted of a felony?*
  • Have you ever been excluded from the Medicare or Medicaid program for conduct that would constitute a misdemeanor, gross misdemeanor of a felony under the law?*
  • Have you ever been disciplined by professional of state ethic or licensing board?*
  • Do you have a working knowledge of the fundamental job duties (essential function) of the position for which you are applying?*
  • If yes, can you perform the essential functions of the job with reasonable accommodation?*
  • If yes, can you perform the essential functions of the job with reasonable accommodation?
    Rows
  • Are you related to anyone employed by AAA Physical Therapy?*
  • Reference (The individuals you will write below will be contacted when necessary any time of the application /hiring process.)*
    Rows

  • “Equal Opportunity Employment Act”

    The policy of this company is to provide every individual a fair and equal opportunity to seekemployment and advancement at the agency without regard to race, color, religion, sex age, national origin, citizenship status, veteran status, disability or factors protected by state or local laws.

    All Applicants:
    (Please read carefully before signing)

    I certify that any information I give during the course of applying for employment is true and complete. I understand that any false, incorrect or misleading information or the omission of any pertinent information including that given at the time my application may be considered as sufficient reason for my discharge, if hired.

    I further understand that this application is not intended to be a contract of employment and that, if I am hired, my employment is at will and can be terminated by either me or the company, with or without notice, for any or no reason. No supervisor or administrator has authority to make an agreement to the contrary changing employment at will.


    This application will be in effect for 90 days from the date indicated below and, if employment is not offered within the 90-day period, I understand that I must reapply to be considered for future employment.

    I also understand that this application for employment in no way obligates the company to employ me.

    I hereby authorize AAA Physical Therapy to investigate my former employment and other references and to make any further investigations deemed necessary in connection with my application for employment and I do hereby release AAA Physical Therapy and all informants of all liability whatsoever resulting from such investigations.

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  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  •  p. 443.979.7171 AAA Physical Therapy, LLC
    admin@AAAPhysicalTherapy.com
    8975 Guilford Rd Ste 170 Columbia, MD 21046    		  f. 667.200.5908
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