NIE Behavioral Health Job Application

  • NIE Behavioral Health Job Application

    Complete this application carefully and include all required certifications, authorizations, and consent signatures.

  • Applicant Information

  • Application Date*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Upload Resume
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  • Authorized to work in the United States*
  • Over 18 years of age*

  • Job Interest

    Position & Availability
  • Employment Type*
  • Available to Start*
     - -
  • Able to perform essential job functions with or without reasonable accommodation?*

  • Education

  • College Name and Address
  • College Course of Study
  • Did you graduate from college?

  • College Degree/Certificate/Diploma

  • High School Name and Address
  • Did you graduate from high school?
  • High School Degree/Certificate/Diploma

  • Professional References

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Employment History

  • May we contact this employer? 1*
  • Format: (000) 000-0000.
  • May we contact this employer? 2*
  • Format: (000) 000-0000.
  • May we contact this employer?*
  • Format: (000) 000-0000.

  • Applicant Certification

  • I certify that the information provided by me in this application and accompanying material is accurate and complete to the best of my knowledge. I understand that if I am employed by NIE HEALTH any misrepresentation or material omission made by me on this application, resume or accompanying material may result in cancellation of this application or immediate discharge from the COMPANY, whenever it is discovered. I hereby give NIE HEALTH the right to contact and obtain information from my references, employers, and educational institutions and to otherwise verify the accuracy of the information contained in this application. Further, I hereby release from liability NIE HEALTH and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information and I release all of my previous employers and all their employees, representatives, officers, directors and agents from any claims arising out of, or in any way connected with, the disclosure to NIE HEALTH of information from my personnel files or any other information pertaining to my employment. I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with NIE HEALTH creates an actual or implied contract of employment. If I am hired, I understand that my employment is at-will and that either NIE HEALTH or I may terminate my employment at any time for any lawful reason. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that, if I am hired by NIE HEALTH my offer of employment is subject to a satisfactory background screening, to include but is not limited to: reference checks, educational and work verification, a health assessment, and a CORI/criminal record. I have read, or have had read to me, this section and fully understand these conditions as outlined above.
  • Date*
     - -
  • Should be Empty: