MC Community Services BHP Application

1

Name* This field is required.

First Name

Last Name

2

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Email* This field is required.

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

5

Are you at least 18 years of age?* This field is required.

YESNO

6

Do you have a High School Diploma or GED equivalent? * This field is required.

YESNO

7

Are you legally authorized to work in the United States?* This field is required.

YESNO

8

Do you possess a valid Maine Driver's License? * This field is required.

YESNO

9

Do you have reliable transportation for work purposes?* This field is required.

YESNO

10

Do you have valid automobile liability insurance?* This field is required.

YESNO

11

Do you currently hold a valid Maine Behavioral Health Professional (BHP) certification?* This field is required.If not, we will help you get required BHP training and obtain certification for free.

YESNO

12

Background Check Acknowledgement* This field is required.Employment with MC Community Services is contingent upon successfully passing all required background checks, including but not limited to criminal history (SBI), Child Protective Services (Child Abuse Registry), Bureau of Motor Vehicles (BMV), and other checks as required by MaineCare and state regulations. Do you understand and acknowledge this requirement?

YESNO

13

Let us know your current or most recent employer* This field is required.Let us know where you're currently working or where you worked last.

Your current or most recent employer's name

Your job title

What is the date range of your employment?

Briefly describe your job responsibilities

14

Let us know the general days and times you're available to work* This field is required.

15

How many hours per week do you want to work?* This field is required.We ask this because it's a part time job

16

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission of fact may result in disqualification from consideration or termination of employment if hired. I understand that this application does not constitute a contract of employment and that employment is at-will.* This field is required.

YESNO

17

SignatureSign this and you're all done! We will reach out about next steps soon.