ULTRA THERAPY SOLUTIONS

Application Form

Please give accurate and complete information. Start with the present or most recent employer, including self-employment, part-time work, military employment, and any work performed on a volunteer basis. Account for your entire employment history, including significant gaps in employment. All information must be included, even if you are attaching a resume.

List all, whether or not degree was obtained:

Please select the documentation systems you have utilized at your current or previous workplaces from the list provided

Please provide the name, work relationship, email address (if available), and telephone number of three Supervisors/Managers or other professional references that are not related to you:

I certify that the statements and information furnished by me in this application are true and correct. I understand that omitted, false or misstated statements on this application are grounds for a refusal to hire, or dismissal, at any time the Company becomes aware of the omitted, falsified, or misstated information. I understand that Ultra Therapy Solutions, LLC. is not obligated to provide me with employment and that I am not obligated to accept employment. I understand that nothing contained in this application, or conveyed during any interview that may be granted, or during my employment, if hired, is intended to create a contract for continued employment with Ultra Therapy Solutions, LLC, except as required by applicable federal, state, and local law. In addition, if an employment relationship is established, unless I am employed in Montana, I acknowledge that my employment and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either the Company or myself, and that this cannot be altered except by an express written agreement signed by myself and a designated officer of the Company. I further understand and agree that no manager or other representative of the Company has the authority to make any verbal promises or commitments to me with respect to any term, condition, or privilege of my employment including compensation. I further understand that no policy, benefit, or procedure contained in any employee handbook creates a contract for continued employment. I understand and agree that, if hired, I will be required to abide by all rules and regulations of Ultra Therapy Solutions, LLC, and that my wages, benefits, and conditions of employment can be changed by the Company at any time in its sole discretion. I agree and hereby authorize Ultra Therapy Solutions, LLC. to conduct a background inquiry to verify the information on this application and any Company form completed by me. I authorize all previous employers or other persons who have knowledge of me or my records, to release such information to Ultra Therapy Solutions, Inc. or their agents. While I understand that this application will be kept on file for a period of up to one year, I further understand that this application will be considered active for a period not to exceed ninety (90) days. I understand that if I wish to be considered for employment beyond this period, I should inquire as to whether or not applications are being accepted for the position in which I am interested and, if so, submit a new application.