Application for Employment
Full Name
*
First Name
Middle Initials
Last Name
Address
*
Street Address (include Apt./Unit #:)
Apt./Unit #:
City
State
Zip Code
E-mail
*
Mobile Number
*
Are you authorized to work in the United States?
Yes
No
Have you ever applied for employment with us?
Yes
No
Do you know or are you related to anyone that currently works here?
Yes
No
Do you have reliable transportation, with a valid driver's license and state minimum insurance?
Yes
No
If hired, would you have access to a computer with internet to complete training?
Yes
No
BCBA Certifications & Training
Are you currently a Board Certified Behavior Analyst?
Yes
No
No, but I ready to test within the next month.
BCBA #
TX Behavior Analyst License #
Is your certification in good standing without pending investigations?
Yes
No
Do you have a current Basic Life Support/CPR certification? (Completed with in-person skills check)
*
Yes
No
Education
College / University Name (Most Recent)
*include City, State
Did you graduate?
Yes
No
Degree Earned:
Are you enrolled in a BACB approved ABA course sequence?
Yes
No
Work History
Employer Name (Most Recent)
City, State
Date Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Position
Phone Number
-
Area Code
Phone Number
What did you like & dislike about this job?
May We Contact?
Yes
No
Work History #2
City, State:
Dates Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Position
What did you like & dislike about this job?
Organizational Values & Career Goals
Of the choices below, what are 3 things you value the most?
Meaningful Work
Flexibility
Being accountable
Making a difference
Being positive
Tolerance & Accepting
Integrity
Having Fun
Taking Risks
Taking charge
Making Money
How does this RBT position help you to achieve your long term goals?
Clinical Approach
Please describe your clinical approach for learners?
Ex: How do you handle escape-maintained behavior, full prompting etc.
Please describe your approach to leading and coaching staff?
How would other staff describe your style?
Availability
Select the time frames that you are available to work:
8:30-11:30am
12:30-3:30pm
4:00-6:00pm
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)
Type lowest pay rate here. Note: we pay based on a matrix of education, training, and experience.
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 Code
Phone Number
Years Known
Reference # 2 Full Name
Position
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Years Known
Applicant Signature
Clear
Date Time Signed
Optional - Attach a Resume
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