Professional Therapy Associates,LLC
Application For Employment
Please print or type: The Application must be fully completed to be considered
Please complete each section, even if you attach a resume.
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.
I understand that if I am employed, any misrepresentation or material omission made by me on this application
will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service,
whenever it is discovered.
I give the employer the right to contact and obtain information from all references, employers, educational
institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release
from liability the employer and its representatives for seeking, gathering and using such information and all other
persons, corporations or organizations for furnishing such information.
The employer does not unlawfully discriminate in employment and no question on this application is used for the
purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local,
state or federal law.
This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer
and still wish to be considered for employment, it will be necessary to fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and
the employer reserves the same right to terminate my employment at any time, with or without cause and without
prior notice, except as may be required by law. This application does not constitute an agreement or contract for
employment for any specified period or definite duration. I understand that no representative of the employer,
other than an authorized officer, has the authority to make any assurances to the contrary. I further understand
that any such assurances must be in writing and signed by an authorized officer.
I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of that’s
person’s need for a reasonable accommodation as required by the ADA.
I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
(Required) Please type owner's Legal First and Last Name below *
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree that I have typed my name and checked the box myself. *
(Required) Check box to submit your electronic signature