General Interest Form | Careers at Ascent Pediatric Group
Thank you for your interest in Ascent Pediatric Group. We are building a values-driven ABA and pediatric developmental services organization rooted in clinical quality, assent-based care, neurodiversity-affirming practice, caregiver collaboration, and professional development. This form allows us to learn more about professionals who may be interested in future opportunities. Submitting this form does not guarantee employment and is not considered a formal application unless an active position is posted.
Applicant Contact Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City and State
*
Location and Opportunity Interest
Are you currently located in or near the Charlotte, NC region?
*
Yes
No, but I am willing to relocate
No, I am interested in remote or future opportunities only
Which type of opportunity are you interested in?
*
Behavior Technician
Registered Behavior Technician
BCBA Trainee / Fieldwork Student
BCBA
Senior BCBA / Clinical Leadership
Administrative or Operations Support
Intake / Scheduling / Billing Support
Speech-Language Pathology
Occupational Therapy
Counseling / Mental Health
Psychology / Diagnostic Services
Educational Consultation
Internship or Student Placement
Other
Availability or timeline
*
Interested immediately
Interested within 1–3 months
Interested within 3–6 months
Interested in future opportunities
Professional Background
Current professional role or title
*
Current credentials or certifications
*
None yet
RBT
BCBA
BCaBA
LBA
SLP
OT
Licensed Counselor / Therapist
Psychologist
Graduate student
Other
Are you currently seeking BCBA fieldwork supervision?
*
Yes
No
Not currently, but I may be in the future
Not applicable
Highest level of education completed
*
Please Select
High school diploma / GED
Some college
Associate degree
Bachelor’s degree
Currently in graduate school
Master’s degree
Doctoral degree
Other
Area of study or degree field
*
Years of experience in ABA, pediatric therapy, education, developmental services, or related fields
*
Please Select
No direct experience yet
Less than 1 year
1–2 years
3–5 years
6–10 years
10+ years
What populations or settings have you worked with?
*
Early intervention
School-age children
Adolescents
Young adults
Autism
ADHD
Developmental disabilities
Intellectual disabilities
Feeding/adaptive skills
School settings
Clinic settings
Home/community settings
Parent/caregiver training
Staff supervision
Clinical leadership
Other
Interest and Values
What interests you about Ascent Pediatric Group?
*
Briefly describe your clinical or professional values.
*
Upload Documents
Resume / CV
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Cover Letter
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: