Employment Application

Employment Application

Behavior Technician
- Pay rate based on education & work experience: initial pay starts at $13.50-$15.50 per hour with the potential to increase up to $20.00 per hour depending on employees performance
- Benefits: sick & vacation pay
- Healthcare: Medical/Dental/Vision
- Retirement: Simple IRA - company match
- Paid 40-hours of training in ABA and employee orientation
- Paid initial and year certification for CBT credential

Job Requirements:
-Clear a criminal background check
-High School Diploma or GED
-18 years or older

This online application will allow you to:
- upload an unofficial transcript of highest education (doc or PDF)
- upload a current resume
- upload copies of active certifications and licenses
These will be required documents in review of your application.

Please complete each item on the form.
Demographics

Please provide your contact information and employment availability and preferences.
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
What are your hour pay expectations?
Type of employment

only part-time only full-time flexible can start part-time and work up to full-time other
Which shifts are you available to work?

Morning 8:15/8:30 to 11:15/11:30am Afternoon 12:15/12:30 to 3:15/3:30pm Later afternoon 3:45/4:00 to 5:15/5:30pm
Specify available if above not applicable.
When can you start?

Month Day Year
Date
What languages do you speak?

English Spanish American Sign Language Other
If other, state languages
Attach a copy of your resume

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I have access to the following (check all that apply):

Vehicle or access to own reliable transportation Cellular phone and daily email access Access to a computer for online training and communication
I can comply with the following requirements (check all that apply):

Clear a criminal and abuse background check Can lift 50 lbs Can run after a bolting child
Can you commit to 1 year with Child Enrichment Center?
Training & Certifications/Licenses

Please provide information about your training or certifications in behavior analysis, mental health services, or your work with children.
Active Certifications/Licenses (check all that apply):

CPR/First Aid Registered Behavior Technician (RBT) Certified Behavior Technician (CBT) Agency Affiliated Counselor (AAC) Licensed Mental Health Counselor Associate (Washington State)
Can you provide proof of completing 40 hours of ABA or RBT training? (certificate of completion)
Attach certificate of completion

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What other trainings or certificates do you have related to your work with children or behavior analysis?
Attach certificate

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Education

Please provide information about your level of education starting from most recent.
Name of School (most recent or highest level)
Degree
Graduation Date

Month Day Year
Date
Name of School (most recent or highest level)
Degree/Subject
Graduation Date

Month Day Year
Date
Name of School (most recent or highest level)
Degree/Subject
Graduation Date

Month Day Year
Date
Other educational programs or schools
Unofficial Transcripts (required for state licensure as a CBT)

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References

As part of our screening and hiring process, we send out Professional Reference Inquiry Forms. Complete email addresses or phone numbers are needed in this section. Please provide at least two references, preferably from your specialty area (not including relatives, current partners, or associates in practice). References should be professionals who have significant personal experience and can attest to your ability, ethical character, and ability to work with others.
Reference 1

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Reference 2

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Reference 3

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Employment History (Internship/Practicum)

Provide information about history of employment or internships/practicums starting from most recent.
Are you currently employed? (check all that apply)

Yes No Part-time Full-time
Are you looking to terminate your current employment?
Are you looking to keep your current employment and add another part-time job?
Name of Company
Job Position & Responsibilities
Company Website
Is this employment current?
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Name of Supervisor
May we contact this employer as a reference?
Email
example@example.com
Phone Number

Area Code Phone Number
Name of Company
Job Position & Responsibilities
Company Website
Is this employment current?
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Name of Supervisor
May we contact this employer as a reference?
Email
example@example.com
Phone Number

Area Code Phone Number
Name of Company
Job Position & Responsibilities
Company Website
Is this employment current?
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Name of Supervisor
May we contact this employer as a reference?
Email
example@example.com
Phone Number

Area Code Phone Number
The relationship between you and the Child Enrichment Center is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Child Enrichment Center. No representative of Child Enrichment Center has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.
First Name Last Name
I attest that I have never been convicted of any crime against children or other persons meaning:
Aggravated murder; first or second degree murder; first or second degree kidnapping; first, second degree assault of a child; first, second, or third degree rape; first, second, or third degree rape of a child; first or second degree robbery; first degree arson; first degree burglary; first or second degree manslaughter; first or second degree extortion; indecent liberties, incest; vehicular homicide; first degree promotion prostitution; communication with a minor; unlawful imprisonment; simple assault; sexual exploitation of minors; first or second degree criminal mistreatment; child harassment; first, second, or third degree criminal mistreatment; abuse or neglect; first or second degree custodial interference; malicious harassment; first or second degree of child molestation, first or second degree of sexual misconduct with a minor; patronizing a juvenile prostitute; child abandonment; promoting pornography; selling or distributing selling; prostitution; felony indecent exposure; criminal abandonment; or any of these crimes as they be renamed in the future.

This electronic signature indicates that all of the information you have provided in this form is correct to your best knowledge and was completed by you.
Signature

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Employment Application

Demographics

Training & Certifications/Licenses

Education

References

Employment History (Internship/Practicum)