Employment Application

Employment Application

Applicants must be 18-years or older for employment.
Applicant Information
Full Name*

First NameLast Name
Are you at least 18 years or older?*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Primary Email*
example@example.com
I am interested in the following position(s)*

Life Enrichment Coach (Early Learner & After School)Behavior Specialist OR Registered Behavior TechnicianBi-Lingual Behavior Intervention Technician or Bi-Lingual Registered Behavior TechnicianProgram SpecialistSite CoordinatorBCBA
Highest Education Level Completed*
BACB/RBT Certification Number (if applicable)
How did you hear about us?
Employment Information
Have you been given a job description or had essential functions of the job explained to you?*

YesNo
Do you understand these essential job functions?*

YesNo
Are you able to perform the essential job functions of this job with or without reasonable accommodation?*

YesNo
Available Start Date*

MonthDayYear
Date
Schedule & Availability*

Part-Time, Weekdays (morning)Part-Time, Weekdays (afternoon)Full-Time, Weekdays, Rotating WeekendsFull-Time, Weekdays, No Weekends
Current Employment Status*

EmployedSelf-EmployedUnemployedStudent
Are you legally eligible to work in the United States?*

YesNo
Criminal Background & History
Please note that a "YES" answer to any of the following questions will not necessarily disqualify you from employment. Factors such as the age and time of the offense, seriousness and nature of the violation, and rehabiliation will be considered when making emplyment decisions.
Have you ever been arrested or convicted of a crime?*

YesNo
Please explain any YES answer
Are you currently awaiting trial for any offense?*

YesNo
Please explain any YES answer
Do you have any responsibilities that might prevent you from meeting your specified work schedule or duties?*

YesNo
Please explain any YES answer
Resume & References
Please UPLOAD your Resume & Cover Letter (if applicable)

Cancelof
Professional references are available?*

Yes, upon requestYes, Included with resumeNo
Please UPLOAD a copy of your High School Diploma (or GED equivalent), Bachelor's Degree, or Master's Degree confirmation (whichever is most recent).

Cancelof
Certification & Release
I certify that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection
of my application or discharge at any time during my employment.

I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
Applicant Signature

Clear
Should be Empty:

Employment Application

Applicant Information

Employment Information

Criminal Background & History

Resume & References

Certification & Release