Board Certified Behavior Analyst (BCBA) Application
This should take about 3–5 minutes to complete
Basic Information
Full Name
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First Name
Middle Name
Last Name
Email Address
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Phone Number
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Format: (000) 000-0000.
City you currently live in?
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Zip code
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Work Eligibility
Are you legally authorized to work in the United States?
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Yes
No
Will you now or in the future require sponsorship?
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Yes
No
Do you have a valid driver's license?
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Yes
No
Do you have a reliable transportation to travel between client homes?
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Yes
No
Do you have currently have active auto insurance?
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Yes
No
Are you comfortable driving between multiple client homes for sessions?
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Yes
No
Location Preferences
Help us match you with clients in your area
How far are you willing to travel for client visits, supervision, or in-person support?
Please Select
Up to 10 miles
Up to 20 miles
Up to 30 miles
Open to longer distances
As we grow, we are expanding into additional areas. Which of the following cities would you be open to supporting? (Select all that apply)
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San Rafael
Novato
Larkspur
Vallejo
Fairfield
Vacaville
None of the cities listed are near me
Are you open to taking cases within 15 - 20 miles of your home?
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Yes
No
Your Availability
What days are you available? (select all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What times are you available?
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Morning (9 AM - 12 PM)
Midday (12 PM - 3 PM)
After School (3 PM - 7 PM)
What type of schedule are you looking for?
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Part-time (10-20 hours/week)
Part-time (20-30 hours/week)
Full-time (40 hours/week)
Are you open to evening hours for parent training or supervision when needed?
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Yes
No
BCBA Credentials
Tell us about your certification and licensure
Are you currently a BCBA?
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Yes
No
BCBA Certification Number
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Experience
How many years of ABA experience do you have?
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Less than 1 year
1 to 2 years
3 - 5 years
5+ years
How many years of BCBA experience do you have?
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Less than 1 year
1 to 2 years
3 - 5 years
5+ years
Have you supervised BTs/RBTs before?
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Yes
No
Have you conducted assessments and written treatment plans before?
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Yes
No
Are you comfortable providing parent training?
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Yes
No
Are you comfortable working in a home-based ABA setting?
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Yes
No
Clinical Experience
Which age groups have you worked with?
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Early intervention
School-age children
Teenagers
Adults
Which areas do you have experience with?
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Functional Behavior Assessments
Treatment planning
Behavior intervention plans
Parent training
BT/RBT supervision
Caregiver collaboration
School collaboration
Insurance documentation
Crisis behavior support
Social skills programming
What funding sources have you worked with?
Private insurance
Medi-Cal
Regional Center
School districts
Other
Other:
Your Caseload & Role Fit
Are you comfortable managing a caseload independently?
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Yes
No
With Support
Are you comfortable managing multiple client cases as part of a caseload?
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Yes
No
Start Date
When are you available to start working with clients?
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Immediately
Within 2 weeks
Within 1 month
More than 1 month
Not sure yet
Do you have any upcoming schedule changes?
Upload Documents
Upload Resume
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Browse Files
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Upload any additional certifications or licenses
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Final Details
Are you willing to complete a background check and fingerprinting if required?
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Yes
No
How did you hear about us?
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Indeed
Facebook
Google Search
Referred by a Behavia Therapy employee
Word of mouth
Other
Who referred you?
Please Specify
Applicant Confirmation
*
I confirm that the information I provided is accurate to the best of my knowledge.
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