Back On Track Physical Therapy
         
 
Put Your Trust in Boston's Largest Aquatic Therapy Group
Phone 1-877-GET BACK | Fax 617-730-5461
 
 
Interested In Becoming A Patient? Click HerePerfect Fit Pro
 
         
 
 

You may fill out the Employment Application below, or email your resume to hiring@backontrackpt.com.


Employment Application

(Pre-Employment Questionnaire)
An Equal Opportunity Employer

Personal Information

First Name:
Last Name:
Email:
Street Address:
City:
State:
Zip Code:
Phone Number:
Are you 18 years or older?
Yes       No
Are you prevented from lawfully becoming employed in this country because of visa or immigration status?    Yes     No

Employment Desired

Position:
Date you can start:
Salary Desired:
Are you currently employed?
Yes       No
If yes, who is your present employer? (optional)
     
Have you applied to Back On Track before? Yes No Where?
When?

Referred By:

Education - High School

Name of School:

Location of School:
Year Graduated:

Education - College

Name of School:

Location of School:
Year Graduated:
Degree Obtained:
Major:
 

Education - Graduate School

Name of School:

Location of School:
Year Graduated:
Degree Obtained:
Major:
 

Please Answer the Following Questions:

Have you ever been on probation or sentenced to jail/prison as a result of a felony conviction or guilty plea to a felony charge? Yes       No    [If "Yes," please provide the following information:]
     
Law Enforcement Authority:
Offense:
Date of Offense:
 
Place and Disposition of Case:
 
Have you ever been fired from a job or resigned to avoid dismissal? If "Yes," please explain. A "Yes" answer will not necessarily bar you from state employment. Yes       No

Former Employers
(List below your last three employers,
starting with the most recent one first.)

Dates Employed To: Dates Employed From:
Company Name:
Employer Name:
Employer Address:
Position:
Salary:
Reason for Leaving:
     
Dates Employed To: Dates Employed From:
Company Name:
Employer Name:
Employer Address:
Position:
Salary:
Reason for Leaving:
     
Dates Employed To: Dates Employed From:
Company Name:
Employer Name:
Employer Address:
Position:
Salary:
Reason for Leaving:

References
(Give the names of three persons not related to you,
whom you have known at least one year.)

Name:
Address:
Business:
Years Acquainted:
Phone Number:
   
Name:
Address:
Business:
Years Acquainted:
Phone Number:
   
Name:
Address:
Business:
Years Acquainted:
Phone Number: