Bios Home Health
Date Time of Interview:
Time of Interview:
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:
Is this a rotating schedule:
Full or 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:
Name of person who conducted this interview:
Add your Email. If you don’t receive a copy, please resubmit.