Director of Physical Therapy Assistant Program Application

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Director of Physical Therapy Assistant Application

Personal Information

First Name:

Middle Name or Initial:

Last Name:

Email Address:

Telephone:

Street Address:

City:

State:

ZIP Code:

Salary Desired:

If hired, how soon would you be available for work?

Education

Do you have a high school diploma or GED?

Yes

Did you graduate college?

Yes

Experience

Do you have the abilities to perform the essential functions of the job for which you have applied?

Yes

How many years of experience do you have in this line of work?

Do you have supervisory experience?

Yes

Employment History

Employer Name:

City:

State:

ZIP Code:

Employer Telephone:

Supervisor Name:

Employment Start Date:

Employment End Date:

Your Position Title:

Reason for Leaving:

Brief Summary of Duties:

Employer Name:

City:

State:

ZIP Code:

Employer Telephone:

Supervisor Name:

Employment Start Date:

Employment End Date:

Your Position Title:

Reason for Leaving:

Brief Summary of Duties:

Do you have a relative employed by Northeast Texas Community College or who serves on the Board of Trustees?

Yes

Have you ever been employed by NTCC in the past or have you ever been part of NTCC as a student, donor, or vendor?

Yes

Background Check

References

Name:

Years Known:

Telephone:

File Uploads

The application for employment is not complete and will not be considered for employment without all documents uploaded.

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Applicant Acknowledgement and Authorization

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of the discovery.

I understand that the submission of an application does not guarantee employment. In consideration for employment, if employed, I agree to conform to the rules, regulations, policies and procedures at all times and understand that doing so is a condition of employment.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information if requested, and I release all parties involved from any and all liability and all damage that may result from providing such information.

I understand that this application is considered current for six (6) months. If I wish to be considered for employment after this period, I must fill out and submit a new application.

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