EmailMe Form - Interview Decision

Area Office:

ABLH Bartlesville

ABLH Tulsa

Bartlesville

Columbia

Hohenwald

Muskogee

OKC

Okmulgee

Sapulpa/Tulsa

Bios Management

Bios Home Health

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

If unsatisfactory- decided not to hire, please explain reason:

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:

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:

Department:

Additional information/Comments:

Name of person who conducted this interview:

First Last

Date Time:

MM / DD / YYYY