Job Application: ABA Behavior Therapist

Title: ABA Behavior Therapist

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

First Name *
Last Name *
Email Address *
Home Address *
City *
Zip Code *
Cell Phone *

Position

Position Applying For *
Desired Region (check all that apply) * Orange County
Long Beach
South Los Angeles
South Bay Beach Cities
West Los Angeles
East Los Angeles
North Los Angeles
San Gabriel Valley
Inland Empire
Are you comfortable driving a 15-20 mile radius? * Yes
No
Unsure
Do you have reliable transportation? * Yes
No
Do you have a valid drivers license? * Yes
No
Do you have active auto insurance? * Yes
No

Availability

Full Time or Part Time *
Date Available to start
Days available to work (check all that apply) * Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Times available to work (check all that apply) * 6am-8am
8am-12pm
12pm-3pm
3pm-6pm
6pm-8pm
Saturdays
Varies based on the day (provide availability details below)
Availability details (if varies by day)
Please Note: The availability indicated above will be used to determine whether or not your availabliity meets our hiring needs. Once hired, a caseload will be created based on the availability indicated above. Changes to availability are not granted within the first 6 months of employment, except under extreme circumstances.

Education

Degree(s) Earned (select all that you have obtained) * High School Diploma
Associate’s Degree
Bachelor’s Degree
Master’s Degree
Doctorate Degree
Area of Study
Upload a copy of degree and/or transcripts (optional)

Certifications

BCBA Certification Status *
If BCBA/ BCaBA certification is in progress, number of courses completed:
Do you have an active Crisis Intervention certification? Yes
No
Expired
Do you have an active CPR or BLS certification? Yes
No
Expired

Work History

Begin with your most recent place of employment
Company Name *
Position Title *
Employment Start Date *
Employment End Date *
Company Contact Information *
Starting Salary *
Ending Salary *
Reason for Leaving *
Company Name
Position Title
Employment Start Date
Employment End Date
Company Contact Information
Starting Salary
Ending Salary
Reason for Leaving
Upload your complete resume *

Languages

Language(s) spoken other than English

Citizenship

Are you a U.S. Citizen? * Yes
No
If not, are you authorized to work in the U.S.? Yes
No
Date of Visa Expiration (if applicable)

Criminal Record

Have you been convicted of a felony? * Yes
No
If yes, please explain

Employment Factors

The following factor(s) is/are of greatest importance to me * Work schedule
Location
Salary/Pay
Benefits
Training and Supervision
Company culture
Indicate desired pay range *
Are you flexible with your desired pay range? Yes
No
Unsure

Commitments

How does this position factor into your short term and long term goals?
Do you have any commitments that could interfere with your employment with BAE? Yes
No
Not sure
Do you have any personal or professional associations that may be a conflict of interest with BAE? Yes
No
Not sure

Employment References

BAE verifies past and current employment and/or education records to determine suitability for employment.
Name of Professional Reference (supervisor or company HR dept)
Contact Information
How did you hear about this position? Personal Referral
Indeed
Craigslist
Facebook
ZipRecruiter
Care
Website search
University
Recruiting event/ job fair
Other

Attestation

I consent to an investigation of my past employment history * Yes
No
Comments
Full Name (Electronic Signature) *
Electronic Signature * I certify that all of the above information is true and correct to the best of my knowledge.
Date *