Job Application

1
Full Name* This field is required.
First Name
Middle Name
Last Name
2
Applying for Position* This field is required.Please scroll down for more selections.
Please Select
Please Select
Behavioral Health Associate- Night
Behavioral Health Associate- Day
Case Manager
Clinician
KAP Facilitator
Residential Supervisor
Scheduling Specialist
3
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
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Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
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Faroe Islands
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The Gambia
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
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Nigeria
Niue
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Northern Mariana
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Palau
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Paraguay
Peru
Philippines
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Poland
Portugal
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Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
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Saint Lucia
Saint Martin
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Samoa
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Senegal
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South Ossetia
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Sudan
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eSwatini
Sweden
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Taiwan
Tajikistan
Tanzania
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Vatican City
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Vietnam
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Isle of Man
US Virgin Islands
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Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Email Address* This field is required.
5
Phone Number* This field is required.
Area Code
Phone Number
6
Birth Date* This field is required.
Month
Day
Year
7
What type of work are you looking for?* This field is required.
Full Time
Part Time
Seasonal/ Temporary
8
Are you legally eligible for employment in this country?* This field is required.If Yes, you will need to provide documentation if hired *
YES
NO
9
What times and days are you available to work?* This field is required.
12 hour Day Shift 8am-8pm
Weekdays
12 hour Night Shift 8pm-8am
Weekends
8 hour Day Shift 8am-5pm
10
Were you referred by a current RYC employee? Please provide name of employee below.
11
Did you graduate from High School or receive a G.E.D.?* This field is required.
YESNO
12
EducationList schools attended. List number of years completed. Indicate degree or diploma earned, if any. Include major field of study (if applicable).
Name of School
Location
Years Attended
Diploma or Degree
Major
High School
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College or University
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Technical or Vocational
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Additional
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High School
College or University
Technical or Vocational
Additional
Name of School
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Years Attended
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Diploma or Degree
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Major
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Name of School
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Major
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Name of School
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Diploma or Degree
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Major
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Name of School
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Location
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Years Attended
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Diploma or Degree
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Major
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Describe any other relevant training you have. Give date, location, and the name of the organization sponsoring the training.
14
List any professional licenses or certificates you hold, or memberships in professional organizations.
15
Do You Have an Alaska Drivers License?* This field is required.
YES
NO
16
Employment and ExperienceList all positions held within the last 10 years, beginning with the most recent employer.
Dates of Employment
Employer Name of Business
Location
Position
Job Duties
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Dates of Employment
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Employer Name of Business
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Location
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Position
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Job Duties
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Location
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Position
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Job Duties
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Dates of Employment
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Employer Name of Business
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Location
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Position
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Job Duties
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Dates of Employment
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Employer Name of Business
Row 3, Column 1
Location
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Position
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Job Duties
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Dates of Employment
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Employer Name of Business
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Location
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Position
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Dates of Employment
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Employer Name of Business
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Position
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Dates of Employment
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Employer Name of Business
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Position
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Dates of Employment
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Employer Name of Business
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Position
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Dates of Employment
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Employer Name of Business
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17
Describe the duties of each position held in the area of child care (including direct care-giving experience, supervision of child care personnel or programs, management or administration).
Huge
Large
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Small
Ok
Ok
18
Describe any other relevant experience or skills you have had, including volunteer work. Give detail, location, supervisors, etc.
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Large
Normal
Small
Ok
Ok
19
Would you be willing to participate in program of continuing education and training for this position?* This field is required.
YESNO
20
May we contact your current employer?* This field is required.
YESNO
21
Attach Cover LetterA cover letter is not required, but you may submit a cover letter and/ or additional references by uploading the documents below.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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22
Attach ResumeA resume is not required, but you may submit a resume if you would like to include additional work experience.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
23
Reference 1
Name
Relationship
Please enter email address
Address (Street, City, State, Zip)
Please enter phone number
24
Reference 2
Name
Relationship
Please enter email address
Address (Street, City, State, Zip)
Please enter phone number
25
Reference 3
Name
Relationship
Please enter email address
Address (Street, City, State, Zip)
Please enter phone number
26
In addition to the references listed above, may the facility contact your previous employers for a reference?* This field is required.
YESNO
27
Licensing HistoryHave you ever been licensed to care for adults or children by the State of Alaska or by another state?
Please Select
Please Select
Yes
No
Select option from drop down
if yes, please explain.
28
Have you ever been denied a license or registration to care for adults or children, or had such a license revoked in Alaska or any other state?
Yes
No
Select option from drop down
If yes, please explain
29
Has a child for whom you were legally responsible (biological child, foster child, adopted child, or child in your care) been removed from your home by the State of Alaska or a child welfare agency in another state, after an investigation of possible abuse and/or neglect?
Yes
No
Select option from drop down
If yes, plese explain
30
Has the State of Alaska or a child welfare agency in another state determined that you neglected or abused a child for whom you were responsible?
Yes
No
Select option from drop down
If ‘Yes’, please explain.
31
Do you have any physical, health, or mental health or behavioral problems, including alcohol or other substance abuse problems, that might affect your ability to care for children?
Yes
No
Select option from drop down
If yes, please explain
32
Do you have a domestic violence problem that could be detrimental to the health, safety, or well-being of children in care?
Yes
No
Select option from drop down
If yes, please explain
33
CRIMINAL CHARGES OR CONVICTIONSAre you currently under indictment or charged with a crime or have you been indicted or convicted of a crime within the past 10 years?
Yes
No
Select option from drop down
if yes, please explain
34
SignatureI certify that this information contains no willful misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge and belief. I hereby authorize the employer to contact the persons listed as references and I understand that the employer may contact others and, at any time, seek verification of any and all information contained herein.
Clear
35
Date of Signature
Date
Year
Month
Day
36
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