BECOME A VENDOR | Digital Therapy, LLC

First name

Last name

Phone

Email

Engagement Type?

Vendor

1099

Are you interested in an FTE role?

Yes

No

Upload Resume

Upload signed W9

Upload Headshot

Upload Logo (if vendor)

Copy & Paste your Bio or CV here

Hourly Rate

Flexible? (Yes/No)

Min Hrs / Wk

Max Hrs / Wk

Identify your skills: Check all boxes that apply:

List additional Platforms/Coding Languages to tag to your profile if not included.

Sector Experience: Check all boxes that apply:

List your certifications. They are NOT REQUIRED to work with or for us. However, some engagements do insist on certified technicians on some projects or even specific components within a project. In those cases, certs matter as they aid in winning new business.

Certification I

Current or Expired?

Certification Provider

Certification II

Current or Expired?

Certification Provider

Certification III

Current or Expired?

Certification Provider

Certification IV

Current or Expired?

Certification Provider

Cert V

Current or Expired?

Certification provider

I grant Digital Therapy LLC permission to use any data I provided in this form in marketing efforts to source & convert opportunities.

I grant permission to use my name & likeness in targeted sales materials and RFPs, but not to be used on digitaltherapy.io.

Signature

Signature field is empty.

Become A Vendor!

Approval notifications sent within 30 days.

Identify your skills: Check all boxes that apply:

Sector Experience: Check all boxes that apply: