Employer Information Form

About Your Business
*Business Name
*Contact Person
*Address
*County
*City, State, Zip   
*Phone, Fax  
*Contact's Email Address
Website (if available)
About the Employee
*Are you looking for       
*How many hours per week?
Please check if you require therapist to be    
*What is the Pay Scale?  
In which modalities would you
require the therapist to be trained?
 
Please decribe the work environment that you are offering
or any comments you would like the therapist to know:
* denotes required field