Brightview Job Application Form

Brightview Care Job Application
Personal Information
Name*

First NameLast Name
E-mail*
example@example.com
Date of Birth*

MonthDayYear
Date
Phone Number*
Address*
City*
State*
Zipcode*
Languages Spoken*
Social Security Number*
Applied Position*
NPI Number (If applicable)
BCBA/RBT Certification #
Were you referred to Brightview?

NoYes
If so, who were you referred by?
Earliest Possible Start Date*

MonthDayYear
Date
Highest Degree Earned*

High School DiplomaAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree
Have you worked with individuals who have Autism Spectrum Disorder (ASD)?*

YesNoOther
Do you have experience in the field of ABA?*

YesNoOther
Have you ever implemented Behavior Intervention Plans (BIPs)?*

YesNo
Work Experience
Previous Employer 1*
Job Title*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Specific Duties*
Reason for Leaving*
May we contact this employer?*

YesNo
Previous Employer 2
Job Title
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Specific Duties
Reason for Leaving
May we contact this employer?

YesNo
Availability and Travel Preferences
Days Available to Work (Check all that apply)*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Behavior Technician-Shifts Available to Work (Click all that apply)*

8am-12pm12pm-4pm4pm-8pm8am-4pm12pm-8pmOpen AvailabilityBCBAs/BCaBAs- check here. (Must be available between 8am-8pm)
Ideal hours per week?*

10-2020-3030-4040+
How far are you willing to travel?*

5 miles10 miles15 miles20 miles25+ miles
References
Name*
Relationship*
Phone*
Please enter a valid phone number.
Name*
Relationship*
Phone*
Please enter a valid phone number.
Additional Information
Special Skills/Current Certifications (Check all that apply)*

CPR/First AidCrisis PreventionRecipients RightsOther
Challenging Behaviors You Have Worked With (Check all that apply)*

AggressionSelf injurious behaviorElopementMeltdowns/TantrumsOther
Do you have reliable transportation?*

YesNo
Do you have reliable technology (cellphone, laptop, computer, tablet, etc.)?*

YesNo
Are you willing to undergo a background check?*

YesNo
Are you authorized to work in the United states?*

YesNo
Have you ever been convicted of a crime (excluding minor traffic violations)?*

YesNo
Please upload resume here:

You can share certificates, diplomas etc.
Cancelof
Authorization to Perform a Background Check

Consent to Background Check:

I hereby authorize Brightview Care LLC and its authorized agents to conduct a background check in connection with my application for employment with Brightview Care LLC. This background check may include, but is not limited to, verification of personal information, criminal history, employment history, educational background, and other relevant records.

Acknowledgment of Rights:

I understand that I have the right to request a written summary of my rights under the Fair Credit Reporting Act (FCRA). I also understand that I will be notified in writing if any adverse employment decision is made based on the results of the background check.
Signature of Applicant*

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Date*

MonthDayYear
Date
Should be Empty:

Brightview Care Job Application

Personal Information

Work Experience

Availability and Travel Preferences

References

Additional Information