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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:
HTS-OK
DSP-TN
Vocational
ABLH-CHHA
ABLH-Nursing
Department:
DSP
Vocational
CHHA/CNA
Program Manager
Other
Additional information/Comments:
Name of person who conducted this interview:
First
Last
Date Time:
MM
/
DD
/
YYYY
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