SLP/SLPA/OT/Ed Specialist Interest Form - Milestones Therapy Group
Please complete this form if you are interested in being considered for a position with Milestones Therapy Group. 
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First Name *
Last Name *
Email Address *
Phone Number *
Job Role *
Are you available for in-person work at a school site in Southern California? *
Zip Code (We'll only contact you about SLP/A positions within reasonable driving distance of your home zip code.) *
Desired Hourly Rate *
How many hours per week are you available to work? (Feel free to list a range.) *
When are you looking to begin a new role? *
Are you authorized to work in the U.S. without restriction?   *
Did a Milestones Therapy Group employee refer you? If so, please list their name. *
Please type your full legal name to certify that:

I understand that employment is contingent upon satisfactory completion of a background check, which may include criminal history, sex offender screening, and verification of employment, education, and licensure. Unsatisfactory results may result in disqualification or termination, consistent with applicable law. 

The information provided in this application is true and complete to the best of my knowledge. I understand that any false statement or omission may result in disqualification from employment or termination if hired.  
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