Employment Application

Acclaim Autism provides equal employment opportunity to all qualified persons, and does not unlawfully discriminate against any person on the basis of race, color, religious creed, creed, religion, sex, ancestry, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Position Applying For*

ABA Clinical Intern (PA)Behavior Technician (PA)Behavior Technician (CA)Board Certified Behavior Analyst (BCBA) (CA)Board Certified Behavior Analyst (LBS/BCBA) (Philadelphia, West Chester, Lancaster)Center Director (Lancaster)

Employment Request
How Did You Hear About This Opportunity?*
What Type of Schedule Do You Want*

Full-timePart-timeEither Full-time or Part-time
Minimum Salary Requested (Specify Annual or Hourly)
If Applicable, Are You Willing to Work Overtime?

YesNo
Work Availability

What hours are you available to work?
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Saturday*
Sunday*

License & Certification
Have You Ever Had Disciplinary Action Brought Against Any of Your Licenses and/or Certifications?

YesNo
Explain Any Disciplinary Action (or N/A):
References
Reference #1 Name

First NameLast Name
Reference #1 Phone Number

Area CodePhone Number
What is Your Relationship to Reference #1?
Reference #2 Name

First NameLast Name
Reference #2 Email
example@example.com
Reference #2 Email
example@example.com
Reference #2 Phone Number

Area CodePhone Number
What is Your Relationship to Reference #2?

Signature / Certification
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for rejection of my application or, if I am employed by this company, for my immediate termination from employment. I authorize Acclaim Autism to make any necessary inquiries and investigations into my education, military, criminal or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to Aclaim Autism by any of the schools, services, licensing, law enforcement and/or government agencies, certifying bodies or employers listed on this application.

YesNo
Please Sign*

Clear
Should be Empty:

Your Information