ETS Employment Application Eastern Therapy Employment Application Step 1 of 4 25% Your Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Phone(Required)Best Time To Call YouBest Time To Call YouMorningsEarly AfternoonLate AfternoonEarly Evening Position You're Applying ForPosition You're Applying For(Required) Front Desk Coordinator Speech-Language Pathologist Occupational Therapist Physical Therapist Are you legally authorized to work in the United States?(Required) Yes No Are You Applying For: F/T P/T PRN What Shift(s) Will You Work? For P/T and PRN AM PM HiddenHours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFriday Add RemovePrevious EmploymentMay We Contact Present Employer? Yes No Employment HistoryBegin With Most Recent EmploymentDatesCompany NameCity, StateTitles and DutiesReason for LeavingSupervisor’s NameTelephone Number Add Remove Education & TrainingInclude Technical/Academic Achievements/Courses Have you obtained a high school diploma or GED certificate?(Required) Yes No College/UniversityName & LocationDiploma/DegreeSubject Of Specialization Add RemoveSpecialized Courses & TrainingName & LocationDiploma/DegreeSubject Of Specialization Add RemoveClerical SkillsTo Be Completed for Clerical PositionsTyping, WPM Shorthand, WPM Medical Terminology Yes No Legal Terminology Yes No List Specific Computer SkillsProfessional & Technical InformationTo Be Completed for Licensed/Registered PositionsNorth Carolina License No. Expiration Date Certificate No. Expiration Date If not licensed in NC, have you applied? Yes No If licensed in another state, list: More About YouMilitary - Branch of ServiceDescribe any military training received relevant to the position for which you are applying:Other special skillsList Other Specific Skills You Have to Offer for This Job Opening:References(Required)Give the Names of Three Persons Not Related to You:NameAddressTelephoneOccupation Add RemoveUpload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 5 MB. 70208
