EmailMeForm
Interview Decision
Area Office:
*
ABLH Bartlesville
ABLH Tulsa
Bartlesville
Columbia
Hohenwald
RHD
Muskogee
OKC
Okmulgee
Sapulpa/Tulsa
Bios Management
Bios Home Health
Type of Interview:
Scheduled
Phone
Walk In
Candidate Interviewed:
*
First
Last
Date Time of Interview:
*
MM
/
DD
/
YYYY
Time of Interview:
*
DECISION:
*
Great candidate, please proceed with background checks
Unsatisfactory interview, decided not to hire
No Show To Interview
Application on hold, waiting on information
Candidate declined job due to rate of pay
Candidate declined job due to other factor
If unsatisfactory- decided not to hire, please explain reason. Or, if candidate declined job due to another factor than rate of pay, please explain:
*
Did this candidate disclose any past criminal history? If so, did you request a disposition?
*
Did you verify there are no gaps in employment?
How many total hours was the schedule discussed/offered:
*
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Is this a rotating schedule:
Full or Part-time:
Full
Part-time
What rate of pay was discussed/offered:
*
If rate of pay was not satisfactory, what was the rate of pay this applicant was looking for:
*
Would there be another rate of pay to add for specialized programs?
*
If hired, what PLPM would this applicant work under:
If hired, what Lead PM case load would this applicant work under:
If hired, what individual/roommates would need to be listed for them to clock into?
Name of Supervisor if hired:
Email of Lead PM:
What procedure code would this person work:
HTS-OK
DSP-TN
Vocational
ABLH-CHHA
ABLH-Nursing
Position:
*
DSP
Vocational
CHHA/CNA
Program Manager
LPN
RN
LPM
Other
If other please list in comments.
Additional information/Comments:
Name of person who conducted this interview:
*
First
Last
Date Time:
*
MM
/
DD
/
YYYY
Add your Email. If you don’t receive a copy, please resubmit.
