Job Application: Clinical Resource Therapist (CRT) – Behavior Consultant

Title: Clinical Resource Therapist (CRT) – Behavior Consultant

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

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 – please note that Therapists will work an 8 hour / day maximum) *	6am-8am 8am-12pm 12pm-3pm 3pm-7pm after 7pm 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.

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 (Note: this section is not required for Administrative positions)
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 *
Reason for Seeking Other Opportunity *
Upload your complete resume *

Languages

Language(s) spoken other than English

Employment Factors

Are 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 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
Name of BAE employee who referred you (if applicable)
Have you ever interviewed with BAE before?	Yes No Don’t recall

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 *