PHYSICAL THERAPIST / PHYSICAL THERAPIST ASSISTANT SKILLS CHECKLIST

This profile is for use by physical therapists and physical therapist assistants with more than one year experience in their discipline and specialty. It will not be a determining factor for the program.

Please enter your full legal name as it appears on your Social Security Card.

First Name: Last Name: Email:

Please check the boxes below for each age group for which you have provided age-appropriate care:

Please indicate your level of experience: A: Theory, no practice  B. Intermittent  C. One-Two Years Current Experience  D. Two-plus years experience, can function independently

The information I have given is true and accurate to the best of my knowledge.  I hereby authorize Advantage RN  to release this Physical Therapist Unit Skills Checklist to facilities of  Advantage RN in relation to consideration of my employment