Evaluation and development of effective plan of care for patients in the outpatient, inpatient and swingbed settings. Supervision of PTA's delivering services, when applicable. Weekend rotation for coverage in IP setting a requirement. Other duties as assigned.
Doctor of Physical Therapy (DPT), IL Licensure
The following information is required in order to help the hospital make the best possible selection of a candidate for employment. All portions of this application must be completed. We appreciate the time you spend filling in the application. Date * Personal Information
First Name *
Last Name *
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Address
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Are you 18 years or older? * Yes No Phone Number * Alternate Phone Number
Is there someone that referred you? Please share their name here.
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Desired Employment
Position
Date you can start *
Salary Desired
Yes No If employed, may we inquire of your present employer? Yes No Have you ever worked for CCH before? Yes No If YES, in which department did you work? When did you work at CCH?
Do you have friends or relatives employed by Clay County Hospital? Yes No If yes, please list: Which shift will you accept? * Day Evening Night Rotating Weekends Which job status will you accept? * Full-Time Part-Time PRN Name & Location of School Number of Years Attended
Did You Graduate? Yes No Subjects Studied Name & Location of School
Number of Years Attended
Did You Graduate? Yes No Subjects Studied Name & Location of School
Number of Years Attended
Did You Graduate? Yes No Subjects Studied General
Subjects of Special Study or Research Work Special Training Special Skills
Former Employer 1
Name of Present or Last Employer
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Start Date
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Phone
Description of Work
Reason for Leaving
Former Employer 2
Name of Previous Employer
Address
City
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Start Date
Leave Date
Job Title
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Phone
Description of Work
Reason for Leaving
Former Employer 3
Name of Previous Employer
Address
City
State
Start Date
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Job Title
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Description of Work
Reason for Leaving
Professional Licenses
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Reference 1
Below, list three professional/work/school references who are not relatives or personal acquaintances. I certify that the facts contained in this application are true and complete to the best of my knowledgeand understand that, if employed, falsified statements on this application shall be grounds for dismissal.Clay County Hospital reserves the right to confer with persons listed by you as a reference, or with anyother individuals, with knowledge concerning your total qualifications for the position. The Hospital will notinquire into your financial status, religious affiliation, marital status, or on other matters unrelated to yourqualifications to fill the position for which you applied. You agree to submit to a criminal backgroundinvestigation upon conditional offer of employment. Information received from such inquiries will beused solely for determining your employability with Clay County Hospital and for no other purpose.This information will not be shared with anyone other than those Hospital representatives involved inthe selection process. Unless you are willing to authorize Clay County Hospital to make such inquiries, yourapplication will not be considered.I hereby consent to having Clay County Hospital contact anyone that it deems appropriate to investigate orverify any information I have given or to discuss my background, past performance, or suitability foremployment. I further consent to being discussed by any person so contacted and I waive all rights tobring any action for defamation, invasion of privacy, or any similar cause against anyone contacted as aresult of what he or she may say about me.I understand that Clay County Hospital has a drug and alcohol policy that provides for pre-employmenttesting as well as testing after employment. Consent to and compliance with such policy is a condition of myemployment.I understand that this document is not an offer of employment, and that an offer of employment, iftendered, does not constitute a contract for continued guaranteed employment. I understand that staffemployees of Clay County Hospital serve at-will, and the employment relationship may be terminated at anytime by either party, for any or no reason, other than a reason prohibited by law.If employed, I will be required to furnish proof of eligibility to work in the United States.If employed on a regular, benefits-eligible basis, I understand that I will be required to makemandatory contributions to the Illinois Municipal Retirement Fund (IMRF). I understand that any benefits Ireceive may be subject to change or discontinuation at any time without prior notice.Clay County Hospital is a tobacco free campus.Clay County Hospital, in accordance with state and federal laws, does not discriminate on the basis of race, color, religion, sex, age, national origin, veteran status, sexual orientation, gender identity, disability, or any other basis of discrimination prohibited by law. Required * YES (by clicking Yes I acknowledge that I have read and understand the terms above) YES
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