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Job Experience Form
Applicants: Please work with your Occupational Therapy Practitioner to complete the form below and submit with your application.
* Indicates required question
Email
*
Record my email address with my response
Name
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Employment Location
*
Your answer
Job Title
*
Your answer
Name of OTR or COTA you worked with
*
Your answer
Describe your exposure to Occupational Therapy
*
Your answer
Signature of Applicant -I certify that the above it true
*
Your answer
To be completed by COTA or OTR
I verify that this applicant has worked with me at the location and confirm that her job title is as stated.
Check all that describes this applicant
Demonstrates interest in Occupational Therapy
Has a neat and clean appearance
Asks questions appropriately
Communicates effectively with staff and patients
Demonstrates initiative to increase learning
Additional Comments :
*
Your answer
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