Applying for:
Pediatric Therapist
Job Application
Universal Rehabilitation Services is an equal opportunity employer. This application will not be used to limit or exclude any contractor from consideration for engagement on a basis prohibited by local, state, or federal law. Contractors must hold a professional license in the state of Texas. Should a contractor need reasonable accommodation in the application process, they should contact a company representative.
Applicant Information
Employment Position
Personal Information
Job Skills/Qualifications
Education and Training
| Institution Name* | Location: City/State | Year Graduated | Degree Earned |
|---|---|---|---|
Employment History
| Company Name* | Position | Supervisor | Phone Number* |
|---|---|---|---|
Applicant References
Please provide 3 references below:
| Name* | Contact* |
|---|---|
Certification and Authorization
The relationship between you and Universal Rehabilitation Services is referred to as “work at will.” This means that your work can be terminated at any time for any reason, with or without cause or notice. No representative of Universal Rehabilitation Services has authority to enter into any agreement contrary to the foregoing “work at will” relationship. You understand that your work is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will work status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President and certify that all statements in this application are true and any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire. By signing you authorize URS to conduct a background check with investigation of your personal and work history and release URS and its agents from any liability that might result from this investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand that Universal Rehab requires the successful completion of a drug and/or alcohol test as a condition of work. I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all state and federal regulations as well as the rules and regulations of Universal Rehabilitation Services.
Electronic Signature Consent
By signing below electronically, you agree that your electronic signature has the same legal effect as a handwritten signature. Your signature and related information (IP address, device details, timestamp) will be recorded for audit purposes in compliance with HIPAA and E-SIGN Act requirements.