Employment Application
Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.
Full Name
*
First Name
Middle Name
Last Name
Any Previous Last Names
*
Birth Date
*
Please select a month
January
February
March
April
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Month
Please select a day
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Day
Please select a year
2025
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Year
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
*
Position Applied
*
Please Select
Behavioral Health Professional
Ed Tech
Other
How did you hear about us
*
Please Select
LinkedIn
Event
Social Media
Company Website
Family / Friend
Employee Referral
University Career Site
Please Specify
*
Available Start Date
*
/
Month
/
Day
Year
How many hours a week can you work?
*
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Background Information
Have you ever been disciplined, discharged, or asked to resign from a prior position?
*
Yes
No
Have you ever resigned from a prior position after a complaint had been received against you or your conduct was under investigation or review?
*
Yes
No
Has your contract in a prior position ever been non-renewed?
*
Yes
No
Have you ever been charged with or investigated for sexual abuse or harassment of another person?
*
Yes
No
Have you ever been convicted of a crime (other than a minor traffic offense)?
*
Yes
No
Have you ever entered a plea of guilty or “no contest” to any crime (other than a minor traffic offense)?
*
Yes
No
Have you ever had a professional license or certificate suspended or revoked in any state, or have you ever voluntarily surrendered, temporarily or permanently, a professional license or certificate in any state?
*
Yes
No
Has any court ever deferred, filed or dismissed proceedings without a finding of guilty and required that you pay a fine, penalty or court costs and/or imposed a requirement as to your behavior or conduct for a period of time in connection with any crime (other than a minor traffic offense)?
*
Yes
No
If you have answered YES to any of the previous questions, provide full details including, with respect to court actions, the date, offense in question, and the address of the court involved. Conviction or other disposition of a crime is not necessarily an automatic bar to employment. OTHERWISE, leave this section blank.
*
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Educational Background
Previous Job History
Any Relevant Certifications
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Educational Background
Name of School
Years of Attended
Did you graduate?
Yes
No
Degree
Name of School
Years of Attended
Did you graduate?
Yes
No
Degree
Name of School
Years of Attended
Did you graduate?
Yes
No
Degree
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Employment History
Employer Name
Location of Employer
Phone Number
Name of Direct Supervisor
Position Held
Timeframe of Employment
Description of Responsibilities
Do you work here currently?
Yes
No
May we contact this employer for a reference?
Yes
No
Employer Name
Location of Employer
Phone Number
Name of Direct Supervisor
Position Held
Timeframe of Employment
Description of Responsibilities
Do you work here currently?
Yes
No
May we contact this employer for a reference?
Yes
No
Employer Name
Location of Employer
Phone Number
Name of Direct Supervisor
Position Held
Timeframe of Employment
Description of Responsibilities
Do you work here currently?
Yes
No
May we contact this employer for a reference?
Yes
No
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Any certifications, trainings, honors, or awards you believe will strengthen your application please provide here
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Disclaimer
My signature below constitutes authorization to check my employment history, including withoutlimitation, criminal arrest and conviction record checks, reference checks, and release of investigatoryinformation possessed by any state, local or federal agency. I further authorize those persons, agenciesor entities that The Courageous Steps Project contacts in connection with my employment applicationto fully provide The Courageous Steps Project any information on the matters set forth above. I expresslywaive in connection with any request for or provision of such information, any claims including withoutlimitation, defamation, emotional distress, invasion of privacy, or interference with contractual relationsthat I might otherwise have against The Courageous Steps Project, its agents and officials or against anyprovider of such information.I understand that information submitted in and with this application may be disclosed to a screeningand/or interviewing committee, which may include board members, administrators, other staff, andmembers of the community. I give my consent to this disclosure.
Signature
*
Date
*
-
Month
-
Day
Year
Date
NOTE:
All application materials become the property of The Courageous Steps Project. None will be returned.Providing any false or misleading information on this application or in the application or employmentscreening process shall be fully sufficient grounds to refuse to employ the applicant or, if the applicant has beenemployed, to immediately dismiss the applicant/employee.
NOTE:
Employment cannot be finalized until the applicant has completed the requirements for complete background checks and fingerprinting as required by Maine state statute.
Submit
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