• Application for Employment

  • Modern Treatment Healthcare Services

    400 Main St. W. Suite 9, Valdese NC 28690
  • An Affirmative Action/Equal Opportunity Employer




    Please list, beginning with most recent
  • Military Information

  • I authorize the release to Modern Treatment Healthcare Services (and any of its licensed agents), information held by parties regarding my previous employment, criminal history record, military records, driving record and scholastic records and hereby release said persons, schools, companies, government agencies, court and law enforcement agencies and authorities, from any damage whatsoever for releasing this information.

    I certify that all information I have provided on this application is true and accurate. I understand that misstatements, omissions, or false or misleading statements which I have provided on this application, my resume and/or in interview(s) shall constitute grounds for refusal to hire or immediate termination from employment.

    I understand that the terms and conditions of employment may be changed at any time without notice by the company. In consideration of employment with Modern Treatment Healthcare Services, I agree to comply with all the policies, procedures and requirements of Modern Treatment Healthcare Services. I understand this application and/or any policy, manual, handbook, or other written document describing such items do not constitute a written contract at this time or in the future. I understand my employment would be at-will and that my employment could be terminated at any time by either party, with or without cause and with or without notice. Any modifications of the at-will employment relationship, oral or written, can only be accomplished by a written document signed by Modern Treatment Healthcare Services owner.

    I have read and understand the above.

  • This employment application is current for 60 days. If you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application.

  • Please return this application with:

    Official sealed copy of your transcripts from school.

    Copy of Social Security Card

    Copy of Driver’s License

    Any Current licensure or trainings

    2 References that we can Contact

    Declaration Page from your Insurance Company (car insurance)

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