Application Form

Join the ARC Team

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Date

MonthDayYear
Date
Personal Information
First Name
Last Name
Preferred Name
Email Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position & Availability
Position Applying For
Desire Start Date

MonthDayYear
Date
Employment Eligibility
Federal law requires employers to verify employment eligibility for all new hires. The following questions are required by law and do not constitute unlawful discrimination.
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for an employment visa (e.g., H-1B, TN, O-1)?
If yes to visa sponsorship, please specify current visa type or anticipated visa needed:
Note: A completed Form I-9 (Employment Eligibility Verification) will be required on or before your first day of employment, as required by the Immigration Reform and Control Act (IRCA) of 1986. Offers of employment are contingent upon satisfactory completion of the I-9 verification process.
Background
Have you ever been convicted of a felony?
A conviction will not necessarily disqualify you from employment. We conduct an individualized assessment based on the nature of the offense, the time elapsed, and its relevance to the position applied for.
If yes, please describe the nature of the conviction(s), date(s), and jurisdiction(s):
Licensure & Credentials
License Type / Credential
e.g., LCSW, LPC, LMFT, Psy.D., Ph.D.
License Number
State of Issue
Expiration Date

MonthDayYear
Date
Has your license ever been suspended or revoked?
Additional Certifications
e.g., EMDR, DBT, Play Therapy
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How Did You Hear About Us?
Please select all that apply:

Other
If referral, who referred you?
If other, please specify:
Acknowledgments & Signature
At-Will Employment

I understand that if hired, my employment will be at-will, meaning that either I or the employer may terminate the employment relationship at any time, for any reason or no reason, with or without notice. Nothing in this application or any other document constitutes a contract or guarantee of employment.

Authorization to Verify References & Credentials

I authorize the organization and its designated representatives to contact my references, former employers, and licensing/credentialing bodies to verify the information provided in this application. I release all parties from any liability arising from the disclosure of such information. I understand that any misrepresentation or omission of material fact on this application may result in disqualification from consideration or, if hired, termination of employment.

Certification

By signing below, I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge.
Signature
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Join the ARC Team