Physical Therapy Aide Application

Physical Therapy Aide Application — Form Fields

This applications template includes 11 fields. Apply for a physical therapy aide position with clinical experience, certifications, and availability. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Highest Education Level (dropdown selection, required) — options: High school diploma, Some college, Associate's degree, Bachelor's degree (Kinesiology/Exercise Science), Other
• Are you currently a PT or PTA student? (multiple choice, required) — options: Yes, No
• CPR/First Aid Certified? (multiple choice, required) — options: Yes, No
• Previous Experience (checkboxes, required) — options: Patient scheduling, Therapy equipment setup, Exercise instruction, Insurance/billing, Electronic health records (EHR), Patient transport
• Availability (checkboxes, required) — options: Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
• Full-time or Part-time? (multiple choice, required) — options: Full-time, Part-time, Either
• Resume (file upload, required)
• Why are you interested in physical therapy? (long text, optional)