Applicant Information

US Wellness, Inc. is an equal opportunity contractor and does not unlawfully discriminate in awarding of contractual agreements. No question on this application is used for the purpose of limiting or excluding any applicant from consideration on a basis prohibited by local, state, or federal law. Equal access to contractual services and programs is available to all persons. All contractors are independent contractors of US Wellness for purposes of all tax laws and will file forms consistent with such status.

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* Professional healthcare licensure/certification and number (if applicable):

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* Expiration date of current professional licensure/certification (if applicable)

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