Gateway Pediatric Therapy
Team Information Form
Employee Name: ___________________________City:_______________
Phone number:____________________________ Zip: _______________
Any allergies scheduling team should be aware of for in-home purposes:
Planned upcoming vacations/time-off:
I, ______________________________ agree that the availability I provided upon hire is
representative of the availability I intend to have for the current season/semester. I
understand that this availability is set until the next company-wide season availability changes
take place (e.g., January, June or September) as the offer of employment was contingent upon
this given availability. I am aware that I can adjust my availability by increasing the days/hours
that I am available, however decreasing days/hours for reasons other than emergencies or
special circumstances discussed with the Clinical Development and Strategy and Human
Resource team will not be permitted. I also understand that working in client’s homes is a
condition of employment for the Behavior Technician position, as discussed during the hiring
Employee Signature: ______________________________________ Date: _____/_____/_____