Our mission is to provide the highest quality
respiratory care and service to our patients, while keeping the
patients rights, well-being and quality of life as the foremost
consideration. This is why we are so selective when bring in a new
employee to the Triad Respiratory family.
It is our goal to
hire dedicated people who are aligned with our mission and values
and strive to maintain the highest standard of quality care and
service for our clients.
Our employees are our greatest
assets. We offer very competitive compensation, benefits packages,
and retirement savings programs.
Fill out the application
below to become part of our staff!
APPLICATION OF EMPLOYMENT OF WORK AT TRIAD RESPIRATORY
SERVICES
Equal
Opportunity Employer
Date
PERSONAL INFORMATION
Name
Phone
Address
Cell
Phone
City
Previous
Address
State
City
Zip
Code
State
IDENTIFICATION
Social
Security #
Other
ID
Drivers
License Number
State
Any
Violations?
Type
Have You
Been Convicted of a Crime?
When?
Explain
EMPLOYERS
Company
Date
Start
Address
Stop
City
Phone
#
State
Supervisor
Position
Pay
Rate
Why Did You
Leave?
Company
Date
Start
Address
Stop
City
Phone
#
State
Supervisor
Position
Pay
Rate
Why Did You
Leave?
Company
Date
Start
Address
Stop
City
Phone
#
State
Supervisor
Position
Pay
Rate
Why Did You
Leave?
WORK HISTORY RELEASE
AUTHORIZATION
By
checking this box, I am authorizing the release of my
employment history and any information concerning my
employment with any company or entity where I am or have
been employed. This information is to be released to
Triad Respiratory Solutions.
AVAILABILITY TO WORK
Morning
Afternoon
Evening
Weekend
EDUCATION
Jr. High
City
Grade Completed
State
Date
Sr. High
City
Grade Completed
State
Date
College
City
Grade Completed
State
Date
Other Training
City
Grade Completed
State
Date
PHYSICAL
RECORD
Do you have any physical
conditions that may limit your ability to
perform the job you applied for?
If you have a limitation, what is
it?
Have you filed any workman
compensation claims?
If you have filed claims,
why?
Are you presently under a
physician's care?
Why?
PERSONAL
REFERENCES
Name
State
Address
Phone
City
Name
State
Address
Phone
City
IN CASE OF EMERGENCY
NOTIFY
Name
State
Address
Phone
City
Relation
AUTHORIZATION
By checking this box, I authorized
the investigation of all statements contained in
this application. I understand that any
misrepresentation or omission of facts requested
is cause for dismissal. Further, I understand
and agree that my employment is for no definite
period and may, regardless of the date of
payment of wages/salary, be terminated at any
time without any previous
notice.
TRIAD RESPIRATORY
SOLUTIONS IS AN EQUAL OPPORTUNITY EMPLOYER, DEDICATED TO A POLICY OF
NON-DISCRIMINATION IN EMPLOYMENT ON BASIS, INCLUDING RACE, CREED,
COLOR, AGE, SEX, RELIGION OR NATION ORIGIN.
