Please complete the Theradynamics Prescreen Questionnaire below. Step 1 of 2 50% First Name* Last Name* Discipline*DisciplineSLPPTPTAOTCOTA1. Have you previously worked for Theradynamics?* Yes, on contract Yes, directly No If entered yes, please provide dates of employment. 2. Do you have a New York License?* Yes No If entered no, please elaborate. 3. Are you working on a limited permit?* Yes No 4. Are you a new grad?* Yes No 5. Are you looking for full time or part time hours?* Full time Part time 6. Are you open to floating?* Yes No 7. Theradynamics assignments are all ongoing unless otherwise stated. Are you open to an ongoing contract?* Yes No 8. Do you have experience with Rehab Optima?* Yes No 9. Are you able to meet the productivity requirement? (PT/OT/SLP – 85%; PTA/OTA – 90%)* Yes No 10. If given an offer, when are you available to start an assignment?* MM slash DD slash YYYY 11. Do you have any time off within the next 3 months?* 12. What areas of New York are you open to? Check all that apply.* Bronx Brooklyn Queens Long Island Manhattan Confirmation* I hereby certify that this information is true and accurate.