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Assistive Technology Professional Application

Personal Information

* - Indicates required fields

How did you hear about us:

General Information

Are you able, at the time of employment, to submit verification of employment of your legal right to work in the US?*
Are you able, at the time of employment, to submit verification of employment of your legal right to work in the US?* (If hired, verification will be required upon employment)

Are you 18 years of age or older?*
Are you 18 years of age or older?*
Have you ever applied with Reliable Medical before?
Have you ever applied with Reliable Medical before?*
Have you ever worked for Reliable Medical before?
Have you ever worked for Reliable Medical before?*
Do you have any relatives currently working for for Reliable Medical?*
Do you have any relatives currently working for for Reliable Medical?*
Are you willing to work overtime? *
Are you able to perform the essential function of the job for which you are applying, with or without reasonable accommodation? *
If driving is a requirement for the job for which you are applying, do you have a valid driver's license? *

Education

High School

Did you graduate?
Degree Earned?

Undergraduate College

Did you graduate?

Graduate Professional

Did you graduate?

Other

Did you graduate?

Employment History

May we contact for reference?

Date Employed

Status

May we contact for reference?

Date Employed

Status

May we contact for reference?

Date Employed

Status

Specialized Training & Activities

REFERENCES

Upload Resume

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION:-
IMPORTANT: Read before signing.

I have read and fully understand the questions asked in this application. I certify that all answers given by me are true, accurate, and complete. I hereby authorize Reliable Medical to obtain employment and educational references for me from all current and prior employers and educational institutions and release all persons from liability for providing such reference information. I hereby release Reliable Medical from any/all liability of whatever kind and nature, which at any time, could result from obtaining and basing an employment decision on such information. I understand that, if employed, Reliable Medical may terminate my employment if I have made any false statements or misrepresentations in this application or during the interview process.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Reliable Medical. However, I further understand that neither the policies, rules, or regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either Reliable Medical or I may terminate my employment at any time with or without notice or cause. I understand that Reliable Medical and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance, or otherwise change all policies, procedures, benefits, or other terms or conditions of employment

My signature below indicates that I have read, understand, and agree to the above statements.

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