Mind is Unique Counseling Services, LLC
Employment Application
Fields marked with * are required. Complete all applicable sections before submitting.
Applicant Information
Name
*
First Name
Last Name
Alias / Other Names Used
*
Birthdate
*
-
Month
-
Day
Year
Date
Phone
*
Format: (000) 000-0000.
Email
*
example@example.com
Social Security Number
*
Have You Ever Worked for DFCS? If, so when and what was your job title/role?
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you find out about us?
*
Employee Who Referred You
Driver License Information
Driver License Number
*
Upload a clear copy of your current driver license using the JotForm link on the final page.
Position(s) Applying For
Position(s) Applying For
Drug Screener
Transporter
Behavioral Aide
Parent Aide
Therapist
Position(s) Applying For
Licensed Therapist
Psychologist
Psychiatrist
Hoteling
Mind is Unique Counseling Services, LLC - Employment Application - Page 1
Back
Next
State Issued
*
Mind is Unique Counseling Services, LLC
Employment Application - Availability and Experience
Fields marked with * are required. Complete all applicable sections before submitting.
Employment Type and Availability
Employment Type You Are Seeking
*
Please Select
Contract
Full time
Part time
Primary Availability
*
Additional Availability
Additional Availability
Weekday Mornings
Weekend Mornings
Weekday Afternoons
Weekend Afternoons
Weekday Evenings
Weekend Evenings
Skills / Experience
Skills / Experience
Bilingual
Note Taking / Reporting
ABA Therapy Experience
Special Education Experience
Mental Health Experience
Employment and Education Summary
Highest Level of Education Completed
*
HS Diploma
Associate
Bachelor
Masters
Specialist
Doctorate
Current / Most Recent Employer
Briefly list relevant behavioral health, DFCS, school-based, ABA, or hoteling experience
Short Answer Question
Explain why you are a good candidate for the position(s) you are applying for.
*
Mind is Unique Counseling Services, LLC - Employment Application - Page 2
Back
Next
Employment Application - References and Submission
Mind is Unique Counseling Services, LLC
Fields marked with * are required. Complete all applicable sections before submitting.
Professional References
Reference #2: Name, Title, Phone Number, and Email *
*
Reference #1: Name, Title, Phone Number, and Email *
*
Required Uploads
Use the links below to upload required documents. Replace the placeholder JotForm links with your live JotForm upload URLs before publishing the form.
Upload Resume Here (JotForm)
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Driver License Copy Here (JotForm)
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Applicant Certification and Signature
I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that false or misleading information may result in disqualification from employment consideration or termination if hired. I authorize Mind is Unique Counseling Services, LLC to verify information related to my application, credentials, work history, and references as permitted by law.
Digital Signature *
*
Date *
*
-
Month
-
Day
Year
Date
Digital signature may be typed and is intended to acknowledge the applicant certification above.
Mind is Unique Counseling Services, LLC - Employment Application - Page 3
Submit
Should be Empty: