Physical Therapy

By Hoosier Homecare Services, LLC | 11/13/2025

Positions open for Physical Therapists to assist patients in improving strength, mobility, and physical function.

Job Category: Physical Therapy
Job Type: Freelance Full Time Part Time

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Please read before completing this application: This agency does not discriminate in the recruitment, hiring, and conditions of employment on the basis of race, color, religion, national origin, sex, marital status, disability, age, or veteran status. No question on this application is intended to secure information to be used in a discriminatory manner. The completed application will be reviewed carefully, but it's receipt does not imply that you will be employed. Employment consideration necessitates that you meet all minimum qualifications required of the position for which you are applying.

Please answer all questions completely.

Name
MM slash DD slash YYYY
Address

General Information

1. Can you furnish proof that you are eighteen (18) years of age?
2. Are you legally eligible to work in the United States?
4. Are you facing any unresolved criminal charges?
6. Have you ever plead guilty or been convicted of a criminal offense?
7. Do you have a valid drivers license?
8. Have you ever been involuntarily discharged or asked to resign from a position?
Are there any reasons why you would be unable to perform, or to perform safely, any of the duties of the position for which you are applying?

Educational Information

Highest Grade Completed (Please circle one)

Reference Information

List at least three individuals who are not former employers or relatives:
Name
Address
City, State, ZIP
Telephone
 

Employment Information

Please list present and former employers. List the most recent first.

May we contact your current employer?
MM slash DD slash YYYY
MM slash DD slash YYYY
Address

MM slash DD slash YYYY
MM slash DD slash YYYY
Address

MM slash DD slash YYYY
MM slash DD slash YYYY
Address

PLEASE READ CAREFULLY BEFORE SIGNING

By signing below, I confirm that the information I have provided in this application is complete and accurate to my knowledge and subject verification by this company. I understand that any false information or deleting any information would disqualify me from consideration for employment and may be justification for my dismissal from employment if discovered following my hire date.

I grant permission for the Company to contact my former employers and the individuals I listed as references in this application, and if I so indicated on the application, I grant permission for the company to contact my present employer. I authorize the schools, persons, previous employers, and other organizations named in this application to provide this company, it's authorized employees, agents or representatives, with any relevant information that may be required to arrive at an employment decision, and hear by release any such schools, persons, employers, agencies, and organizations from any and all liability which may otherwise incur as a result.

I understand that this application does not constitute a contract of employment.

In the event that I am employed, I understand that all employees are subject to termination at the discretion of the company. If, in the event I choose to voluntarily terminate my employment, I am free to do so at any time, and if I choose to give the proper notice of termination, the Company may either permit me to continue my employment during the notice period or may accept my registration immediately.

I understand that, if employed by the Company, my compensation, hours of employment, and all other terms and conditions of employment are subject to modification or change by the company at any time in the Company's sole discretion.

I authorize the Company to supply my employment record, in whole or in part, and in confidence to any prospective employer, government agency, or other party, with a legal and proper interest.

I understand that completion of this form does not guarantee me status as an applicant or any consideration for employment unless I meet all stated minimum qualifications required of the position for which I am asking to be considered.

I will immediately notify the company should I be convicted of a felony or any crime that involves dishonesty or a breach of trust while my employment application is being processed or during my employment if hired.

I understand this is a conditional hire pending the results of a criminal history and background check (if applicable) and reference checks. I have read the above statement and accept the same as a condition of my employment with the Company, if I am hired.

MM slash DD slash YYYY

Background Check Consent Form

Hoosier Homecare Services has my permission to obtain a criminal history report. I understand that this information will be strictly confidential.

MM slash DD slash YYYY
PLEASE FILL OUT THIS FORM COMPLETELY
Name
MM slash DD slash YYYY
This field is hidden when viewing the form
Gender
Address

Request for Reference

To:

Address

To assist me in securing employment with Hoosier Homecare Services, I hereby authorize you to supply this Company with the information requested below. In consideration of your help, I hereby waive any claim against you regarding such information.

MM slash DD slash YYYY
MM slash DD slash YYYY
I would appreciate your filling in the blanks below and returning this form directly to the company.
MM slash DD slash YYYY
Did this person work for you as indicated above?
Were duties performed satisfactory?

Scale

E-Excellent; G-Good; A-Average; S-Satisfactory; U-Unsatisfactory
MM slash DD slash YYYY
Please return to Company in the attached envelope or Fax to (765) 622-1002

Apply for this position