Looking to Join – Universal Rehab Services, Inc.

Job Opportunities

We are always looking to grow our team with the most caring, qualified professionals. We work with PT, PTA, OT, OTA, SLP, CSW, RD, MSW, RN, LVN, and more. We do everything in our power to ensure that our professionals are as well taken care of as our patients by offering numerous benefits to separate us from other agencies. If interested in becoming part of the Universal Rehab family, please complete the following or contact our recruiting team at (281) 820-9462.

Please Download And Complete The Following Forms

JOB APPLICATION

Universal Rehabilitation Services, Inc.

P.O. Box 691689 Houston, Texas

77269-1689 Tel: 281-820-9462 Fax: 281-820-0769

Universal Rehabilitation Services is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

– Step 1 of 5

Please fill out all of the sections below:

Applicant Information:

Applicant Name: *

Address: *

City, State and Zip Code: *

Telephone Number(s): *

Email Address: *

Date of Application: *

Employment Position

Position(s) applying for:

How did you hear about this position? *

On what date can you start working if you are hired? *

Visit rate desired: *

Personal Information

Do you have any friends, relatives, or acquaintances working for Universal Rehabilitation Services *

If yes, state name & relationship:

Are you a U.S. citizen or approved to work in the United States? *

What document can you provide as proof of citizenship or legal status? *

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

Note:

(Universal Rehabilitation Services complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that once hired a staff member may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

Education and Training

High School

Name

Location

Address Line 1

City

State

Year Graduated

Degree Earned

Education and Training

College/Universities

Name

Location

Address Line 1

City

State

Year Graduated

Degree Earned

Education and Training

Vocational School/Specialized Training

Name

Location

Address Line 1

City

State

Year Graduated

Degree Earned

Military:

Are you a member of the Armed Services?

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

Address Line 1

City

State

Zip Code

Employer Telephone:

Dates Employed:

Reason for leaving:

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

Address Line 1

City

State

Zip Code

Employer Telephone:

Dates Employed:

Reason for leaving:

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

Address Line 1

City

State

Zip Code

Employer Telephone:

Dates Employed:

Reason for leaving:

References:

Please provide 3 professional reference(s) below:

Reference 1 *

First

Last

Reference 2 *

First

Last

Reference 3 *

First

Last

Additional Information:

AT-WILL ENGAGEMENT

The relationship between you and the Universal Rehabilitation Services (URS) is referred to as “engagement at will.” This means that your engagement can be terminated at any time for any reason, with or without cause, or notice. No representative of Universal Rehabilitation Services has authority to enter into any agreement contrary to the foregoing ” engagement at will” relationship. You understand that your engagement is “at will,” and that you acknowledge that no oral or written statements or representations regarding your engagement can alter your at-will engagement status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President and certify that all statements in this application are true and any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire. By signing you authorize URS to conduct a background check with investigation of your personal and work history and release URS and its agents from any liability that might result from this investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand that the URS may request the successful completion of a drug and/or alcohol test as a condition of engagement. In the event of engagement, I understand that false or misleading information given in my application or interview (s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. I also understand that my signing of this document verifies my right to work in this country. Should that change, I must notify URS immediately of this update.

Applicant Signature:

Dated:

The contract

Download

File Upload

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CONFIDENTIAL

Background Check Authorization

Print Name: *

Former Name(s) and Dates Used: *

Current Address Since: *

Previous Address From:

Social Security Number: *

DOB *

Telephone Number: *

Checkboxes *

The information contained in this application is correct to the best of my knowledge. I hereby authorize Universal Rehabilitation Services and its designated agents and representatives to conduct a comprehensive review of my background including a consumer report and/or an inves-tigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residenc-es; employment history, education background, character references; drug testing, civil and criminal his-tory records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, OIG Exclusion Check, DADS Employability Check and any other public records. I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to Universal Rehabilitation Services or its agents. I fur-ther authorize the complete release of any records or data pertaining to me which the individual, com-pany, firm, corporation, or public agency may have, to include information or data received from other sources. Universal Rehabilitation Services and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including, but not limited to, addresses, social security numbers, and dates of birth.

Date *

Signature *

Please Upload The Credentials Listed Below

– Step 1 of 8

Original and Renewal of professional licenses; including CCC for Speech Pathologists and National Certification for Occupational Therapists.

File Upload *

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Professional Liability Insurance (if you have it) along with any other form of business insurance you may have.

File Upload *

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Texas Driver’s License and Auto Insurance.

File Upload *

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CPR Certification

File Upload *

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TB skin test or X-Ray results

File Upload *

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Signed Hepatitis B vaccine decliner form or immunization record

File Upload *

Click or drag a file to this area to upload.

Social Security Card

File Upload *

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Updated Resume

File Upload *

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Form W-9

Download

File Upload

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