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Healthcare Consulting and Rehabilitation Services

"We put the Caring into Health Care"

 

 

 

ON-LINE APPLICATION FORM:

Holsman Healthcare, LLC (HHC) is an equal opportunity employer. All applicants will be considered regardless of race, gender, marital status, national origin, sexual orientation, and all other legally protected interests.

(*) Indicates a required field.

First Name:*
Last Name:*
Street Address:
City:
State:
Zip Code:
Home Phone Number:
Work Phone Number:
E-mail:*


Position for which you are applying:

Are you available to work:
Full time
Part time
Per diem
Temporary

Date at which you will be available to begin work (M/D/YR):

Have you ever applied to HHC before?
No
- Date:

Are you currently employed?
No
Yes

Do you have the right to be employed in the United States (i.e. if applicable, do you have the necessary Visa or Immigration Status to be legally employed)?
No - Explain:
Yes

Will you be able to travel if the position requires it?
No
Yes

Have you ever been convicted of a felony?
No
Yes - Explain:

Employment History:
Please provide the information regarding your current and previous jobs. Start with your current or most recent employment.

 

Employer:
Address:
Telephone Number:
Job Title:
Supervisor Name:
Dates Employed (from - to):
Salary Received (starting - final):
Reason for Leaving:


 

Employer:
Address:
Telephone Number:
Job Title:
Supervisor Name:
Dates Employed (from - to):
Salary Received (starting - final):
Reason for Leaving:


 

Employer:
Address:
Telephone Number:
Job Title:
Supervisor Name:
Dates Employed (from - to):
Salary Received (starting - final):
Reason for Leaving:


Please tell us of any special personal skills and qualifications you feel may enhance your ability to perform your job:

Do you speak any foreign languages?
No
Yes - Please specify language and proficiency level:

Describe any additional skills, training, or extra-curricular activities you feel may have bearing on your job performance:

References:
Please provide three professional references:

 

Name:
Address:
Phone Number:
Best time to contact them:
Relation:


 

Name:
Address:
Phone Number:
Best time to contact them:
Relation:


 

Name:
Address:
Phone Number:
Best time to contact them:
Relation:

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Holsman Healthcare  is a physical rehabilitation service firm known for its caring and high quality services. We provide direct patient/client care through our highly skilled and professional Physical Therapists, Occupational Therapists and Speech Language Pathologists. Holsman Healthcare is also a healthcare staffing company that specializes in the placement of  allied health professionals (PT, OT, and SLP).