Registered Behavior Technician (RBT) Application

Registered Behavior Technician Application

Welcome! Please complete the application form to join our team dedicated to providing exceptional ABA therapy.
Position Overview:

Registered Behavior Technician Application (RBT) works under the supervision of a Board Certified Behavior Analyst (BCBA) to implement individualized behavior intervention plans. This role includes direct one-on-one therapy, data collection, and collaboration with families and clinical teams across home, school, and community settings. Scheduling may include up to six (6) days per week, based on client needs and staff availability.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address (Street, City, State, ZIP)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Preferred Contact Method*
Availability (Select all that apply)*

Morning (8 am to 12 pm)Midday (12 pm to 4 pm)Evening (4 pm to 8 pm)
Are you legally eligible to work in the United States?*

YesNo
Do you have reliable transportation?*

YesNo
Do you have a valid driver’s license?*

YesNo
Highest Level of Education*
RBT Certification Number
Upload RBT Certificate (Optional)

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Upload CPR/First Aid Certification (Optional)

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Employment History

Please upload your resume OR complete the section below by listing your three most recent employers or volunteer experiences.
Upload Resume

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1. Company Name*
Position/Title*
Supervisor Name*
Supervisor Phone or Email*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
2. Company Name
Position/Title
Supervisor Name
Supervisor Phone or Email
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
3. Company Name
Position/Title
Supervisor Name
Supervisor Phone or Email
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Have you ever been convicted of a crime other than a minor traffic violation?*

YesNo
If yes, please explain.
Do you consent to a background check?*

YesNo
Date*

MonthDayYear
Date
Should be Empty:

Registered Behavior Technician Application

Employment History