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Our Story
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Contact Us
New Hire Intake Form
At Home New Hire Intake Form
Division ( Select all that apply)
*
At Home - Home Care: employees that work in the home care setting (can be PRN, PT, FT)
ETPC-ALF/ILF: employees that work in the facility setting (can be PRN, PT, FT)
PRN to FT: A PRN employee that’s switching to FT
PRN Facility to Home Care: PRN EE that worked in a facility (hourly rate) that will now do PRN HC (visit rate)
PRN Home Care to Facility: PRN HC (visit rate) that will start to take cases in facilities as a PRN (hourly rate)
Will this new hire be situated in OH (Blue sky)?
*
Yes
No
Employee Name
*
*
Email Address
*
Cell Phone Number
*
Home Street Address
*
Home City
*
Home State
*
Home Zip Code
*
Employment Status
*
Please Select
Full-Time
Part-Time
Per- Diem
Discipline
*
Please Select
PT
OT
SLP
PTA
COTA
Rehab Aide
Other (indicate below in the comments)
What work state(s) will the employee be working in?
*
What are the weekly hours employee will work?
*
Is there a set start date?
*
Yes
No- Pending assignment (for PRN only)
Facility Name
*
Start Time
*
How will employee be paid? (Check all that are applicable)
*
Hourly Rate - PRN
Hourly Rate - PT
Hourly Rate - FT
Salary - FT
Per Visit - Home Care
Enrolling in Medical (Only for FT)?
*
Yes
No
Not Eligible
Unknown
Is New Hire A:
*
Current Per Diem
Rehire
Receiving Sign on Bonus?
*
Yes
No
Receiving COBRA Coverage?
*
Yes
No
Is the new hire vaccinated for COVID-19?
*
Yes
No
Comments
Submitted By:
*
Please Select
charmip@athometherapies.com
emmal@athometherapies.com
mariej@athometherapies.com
rkelly@enhancetherapies.com
veral@athometherapies.com
If you are human, leave this field blank.
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At Home Careers
Refer A Friend
Full Name
Email Address
Current Employer
Referral Candidate Full Name
Referral Candidate Phone
Referral Candidate Email
Referral Candidate Discipline
Referral Candidate City
Referral Candidate State
Referral Candidate Zip Code
Referral Candidate's Resume
Submit
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