Division (Select all that apply)*

At Home – Home Care: employees that work in the home care setting (can be PRN, Part Time, Full Time

ETPC-ALF/ILF: employees that work in the facility setting (can be PRN, Part Time, Full Time)

PRN to Full Time: A PRN employee that’s switching to Full Time

PRN Facility to Home Care: PRN EE that worked in a facility (hourly rate) that will now do PRN HC (visit rate)

PRN Home Care to Facility: PRN HC (visit rate) that will start to take cases in facilities as a PRN (hourly rate)

Employee Name*

First

Last

Email address*

Cell Phone Number*

Home Street Address*

Home City*

Home State*

Home Zip Code*

Employment Status*

Please selectFull TimePart TimePRN

Discipline*

Please selectPTOTSLPPTACOTARehab AideOther (indicate below in Comments)

What work state(s) will the employee be working in?*

What are the weekly hours employee will work?*

Is there a set start date?*

Please selectYesNo – Pending Assignment (for PRN Only)

Start Date*

Start Time*

Facility Name*

How will employee be paid (check all that are applicable)?*

Hourly Rate – PRN

Hourly Rate – Part Time

Hourly Rate – Full Time

Salary – Full Time

Per Visit – Home Care

Hourly Rate*

Annual Salary*

Per visit rate*

Weekly Hours*

Enrolling in Medical (only for Full Time)?*

Yes

No

Not Eligible

Unknown

Is New Hire A:

Current Per Diem

Rehire

Receiving Sign on Bonus?*

Yes

No

Amount of Sign on Bonus*

Payment Terms*

Contract Length*

Receiving COBRA Coverage?

Yes

No

Monthly Amount of COBRA

Number of Months Covered*

Is the new hire vaccinated for Covid?*

Yes

No

Comments

Submitted By*

Please selectcharmip@athometherapies.comemmal@enhancetherapies.comjennifera@enhancetherapies.commariej@athometherapies.comrkelly@enhancetherapies.comveral@athometherapies.com

Untitled

Send

This field should be left blank