Job Application: Clinical Resource Therapist (CRT) – Behavior Consultant Title: Clinical Resource Therapist (CRT) – Behavior ConsultantFields marked with an asterisk (*) must be filled out before submitting.Personal DetailsFirst Name *Last Name *Email Address *Home Address *City *Zip Code *Cell Phone *PositionPosition Applying For * Behavior Therapist Clinical Resource Therapist Behavior Consultant Supervisor Program Manager Program Director Scheduler Job Mentor Financial Analyst Office AssistantDesired 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 EmpireAre you comfortable driving a 15-20 mile radius? * Yes No UnsureAvailabilityFull Time or Part Time * Full Time (30-40 h/w) Part Time (20-29 h/w) Less than 20 h/wDate Available to startDays available to work (check all that apply) * Monday Tuesday Wednesday Thursday Friday SaturdayTimes 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 is primarily relevant to Clinical Staff. The availability you note 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 you have indicated above. Changes to availability are not granted within the first 6 months of employment, except under extreme circumstances. Please ensure that your availability above is accurate.EducationDegree(s) Earned (select all that you have obtained) * High School Diploma Associate’s Degree Bachelor’s Degree Master’s Degree Doctorate DegreeArea of StudyUpload a copy of degree and/or transcripts (optional) CertificationsBCBA Certification Status (Note: this section is not required for Administrative positions) None (not in BACB coursework) BCaBA Certified BCBA Certified BCBA-D Certified BACB certification in progressIf BCBA/ BCaBA certification is in progress, number of courses completed: 0 1 2 3 4 5 6Do you have an active Crisis Intervention certification? Yes No ExpiredDo you have an active CPR or BLS certification? Yes No ExpiredWork HistoryBegin with your most recent place of employmentCompany Name *Position Title *Employment Start Date *Employment End Date *Company Contact Information *Reason for Seeking Other Opportunity *Upload your complete resume * LanguagesLanguage(s) spoken other than EnglishEmployment FactorsAre you interested in working with the following ages (check all that apply. Note: this section is not required for Administrative positions) Early Childhood (0-5) Middle Childhood (6-12) Teens (13-19) Young adult (20+)The following factor(s) is/are of greatest importance to me * Work schedule Location Salary/Pay Benefits Training and Supervision Company cultureIndicate desired pay range *Are you flexible with your desired pay range? Yes No UnsureCommitmentsHow 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 sureDo you have any personal or professional associations that may be a conflict of interest with BAE? Yes No Not sureEmployment ReferencesBAE verifies past and current employment and/or education records to determine suitability for employment.Name of Professional Reference (supervisor or company HR dept)Contact InformationHow did you hear about this position? Personal Referral Indeed Craigslist Facebook ZipRecruiter Care Website search University Recruiting event/ job fair OtherName of BAE employee who referred you (if applicable)Have you ever interviewed with BAE before? Yes No Don’t recallAttestationI consent to an investigation of my past employment history * Yes NoCommentsFull Name (Electronic Signature) *Electronic Signature * I certify that all of the above information is true and correct to the best of my knowledge.Date *
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