Application Form



The relationship between you and the A-1 Rehab & Recruitment is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the A-1 Rehab & Recruitment. No representative of A-1 Rehab & Recruitment has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your atwill employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

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A-1 Rehab & Recruitment 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.
Please fill out all of the sections below

Applicant Information

Employment Position

Personal Information

Job Skills/Qualifications

(Note: A-1 Rehab & Recruitment 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 a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional. )

Education and Training

High School
Vocational School/Specialized Training


Previous Employment

References: Please provide 3 personal and professional reference(s) below:

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