Behavioral Counseling Services LLC Affiliation with Brothers and Keepers Corp. Employment Applicatio...

ACHIEVING BETTER COPING SKILLS LLC

EMPLOYMENT APPLICATION
Your Contact Information
First Name
Last Name
E-mail Address
example@example.com
Date of Birth

MonthDayYear
Date
Cell Phone
Last Four of your Social Security Number (This number will be your Company 4 digit Pin)
Which position are you applying for?
What is your experience working with Group Home Children or At-Risk Youth?
What is your experience with Administration Duties?
List any languages you can speak fluently:
Work Experience and Previous Employer (For the past 10 years starting with your most recent)
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #2
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #3
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #4
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
Work Experience #5
Job Title
Company Name
Supervisor Name and Title
example@example.com
Supervisor Phone
Job Description: Include duties, work schedule, etc.
Reason for leaving:
EDUCATION (Click all the has been completed)

High School / GEDAssociates DegreeBachelors DegreeMaster"s DegreeVocational TrainingOther
NAME OF HIGH SCHOOL
NAME OF COLLEGE(S)
What is your expected Hourly Rate?
When can you start?

MonthDayYear
Date
What is your availability?

Weekends 9am-9pmWeekends 9pm-9amWeekdays 9am-5pmWeekdays 3pm-11pmWeekdays 9pm-9amOther
Check all documentation you can provide:

Fingerprint Clearance CardCPRFirst AidCIT / Jireh / CPI trainingHigh School / GED diplomaCollege Diploma or CreditsAZ Driver's LicenseAuto InsurancePhysical (within 2 years)Drug TestDriving Record
Please check all that apply to your legal history

Convicted of a FelonyDUI or DWICurrent Suspended LicenseUnable to work with ChildrenSmoke CigarettesSmoke MarijuanaUse any form of DrugsDrink AlcoholHealth ConditionsTaking Prescription Medication
Please explain in detail of any checked marks of your legal history above:
Signature*
REFERRED BY ABC EMPLOYEE

NOYES (Include Name)
TODAY"S DATE

MonthDayYear
Date
Should be Empty: