H-1 Employee Application

Introduction to the Position

Before Applying, please view the links below to learn more about ABA & Autism.
What is Applied Behavior Analysis?

Learn about Autism

Examples of ABA Sessions:

ABA Session Example 1

ABA Session Example 2

**Please note that our examples do not include interferring behaviors that an RBT may encounter to include yelling, crying, aggression, self injury.**
Application for Employment
Full Name*

First NameMiddle InitialsLast Name
Address*

Street Address (include Apt./Unit #:)

Apt./Unit #:

CityState

Zip Code
Position Applying For:
E-mail*
Mobile Number*
Are you authorized to work in the United States?*

YesNo
Do you know or are you related to anyone that currently works here?*

YesNo
Do you have reliable transportation, with a valid driver's license and state minimum insurance? Note: You may be assigned in-home cases and be required to travel within Killeen.*

YesNo
RBT Certifications & Training
Are you currently a Registered Behavior Technician? (Note: an RBT is required for this position)*

Yes, I am currently a RBTNo, I am not an RBTNo, but I have completed the 40 hour RBT training and need competency check.My RBT is expired or inactive
If you are an RBT, is your certification in good standing without pending investigations?

YesNo
Do you have a current Basic Life Support/CPR certification? (Completed with in-person skills check)*

YesNo
Other certifications, training, and experience you have:
Education
Are you at least 18 years of age and have a high school diploma? Note: When applying to become an RBT, this information will be required.*

YesNo
College/University Education
College / University Name (Most Recent)
*include City, State
Did you graduate?

YesNo
Degree Earned:
Are you enrolled in a BACB approved ABA course sequence?

YesNo
Work History
Employer Name (Most Recent)*
City, State*
Date Started*

MonthDayYear
Date
Date Ended*

MonthDayYear
Date
Position*
Phone Number*

Area CodePhone Number
Reason for leaving?*
May We Contact for a Reference?*

YesNo
Work History #2*
City, State:*
Dates Started*

MonthDayYear
Date
Date Ended*

MonthDayYear
Date
Position*
Reason for leaving?*
Availability

We work on a block schedule system. Our sessions have some flexibility for our client's needs and are offered in 3 hour increments or 2-hour increments as generally noted below.

Select the time frames that you are available to work:

	8:00am-11:30am	11:30am-2:30pm	3:30-5:30pm	4:00pm-6:00pm
Monday
Tuesday
Wednesday
Thursday
Friday

I need to work a minimum of....(hours per week)
Type your ideal # of hours
I can work no more than....(hours per week)
Type maximum # of hours you can work
Ideally, I want to work... (hours per week)
Please be honest - how many hours do you really want?
I need to make a minimum of...(dollars per hour)
Note: We pay based on experience and education
Date I can start
Professional References

Please only include professional references - no friends or family members.
Reference # 1 Full Name*
Position*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Years Known*
Reference # 2 Full Name*
Position*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Years Known*
EMPLOYMENT APPLICATION DISCLAIMER AND ACKNOWLEDGEMENT. I certify that the information contained in this application is correct to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. *

Applicant Signature Clear
Date Time Signed
Optional - Attach a Resume

Browse Files

Cancelof
Should be Empty:

Introduction to the Position

Application for Employment

RBT Certifications & Training

Education

Work History

Availability

Professional References