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