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Miller Rd Akron, OH 44333 (330) 630-1860 fax: (330) 630-3198 JOB ORDER Today s Date: Contact Person: Telephone: FAX: (330) (330) Company: Billing Address: (Please circle requested services) Job Order for: FULL-TIME PART-TIME: Requesting: PT Area of Need: OUT-PATIENT PTA OT SNF hours/day COTA HOSPITALS SLP SCHOOL OTHER: Date Position: Starts: Finishes: Job Order Specifics: PRN Response: Proprietary Document of PRN Therapy Services, Inc.. Word/Agreement/Template/Job Orders/Joborder-contract-BS-2 Originated 12/99 Rev.1/11 UPDATED 12/31/12 JOB ORDER IS SUBJECT TO THE TERMS AND CONDITIONS SET FORTH BELOW The Facility listed above hereby requests that LLA Therapy (dba PRN Therapy Services, Inc) provides the services requested in Section VI of this job order.. COMPLIANCE WITH CIVIL RIGHTS ACT/FEDERAL REGULATIONS - Acceptance of this Agreement is evidence of both parties intent to comply with Title VI and Title VII of the 1964 Civil Rights Act and subsequent amendments, which prohibits discrimination because of race, sex, national origin, age, color, or handicap in any facet of either party s operation..
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