Tel:
907.726.5330
Email us:
Stagesak@gmail.com
AK Behavior Matters Job Application
* Required
Date
*
MM
/
DD
/
YYYY
Name
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Address
Your answer
Locations for Employment
*
Alaska- Eagle River/ Anchorage
Alaska-Juneau
Which position(s) are you interested in?
*
Behavior Tech (min of AA degree)
Registered Behavior Tech (Min of AA degree, RBT certification)
BCBA (min of Masters & BACB Certification)
BCABA (Min of Bachelor's degree & BACB Certification)
Occupational Therapist
CCC-SLP
LCSW
LPC
Neuropsychologist
Psychiatrist
Medical Biller (Eagle River location only)
Office Support (Eagle River location only)
Required
Type of Employment
*
Full Time 30-40 hours
Part Time 10-29 hours
1099 Contractor (SLP, OT, PT, BCBA only)
Required
Salary or Hourly requirements
Your answer
Date available to begin employment
MM
/
DD
/
YYYY
Days available for an interview (Select all that apply)
M-F 9-12
M-F 12-4
M-F 4-6
Other:
Days and times of availability if hired.... (Select all that apply)
M-F 9-12
M-F 12-4
M-F 4-6
Weekends
Other:
CAQH number (Certified or Licensed applicants)
Your answer
NPI Number (Certified or Licensed applicants)
Your answer
Certification Number (Certified applicants)
Your answer
License Number (Licensed applicants)
Your answer
Are you a citizen of the USA?
*
Yes
No
If no, are you authorized to work in the USA?
*
Yes
No
Have you ever worked for this company?
*
Yes
No
If yes, when
MM
/
DD
/
YYYY
Have you ever been convicted of a felony?
*
Yes
No
Education-Where did you attend? Dates?
Your answer
College- Did you graduate?
Yes
No
Clear selection
Education- Other
Your answer
Other- Did you graduate?
Yes
No
Clear selection
References (Name, Company, Email, Phone, Relationship)
Your answer
References (Name, Company, Email, Phone, Relationship)
Your answer
References (Name, Company, Email, Phone, Relationship)
Your answer
Insert Submit Cover (and send to
officeak@behaviormattersllc.com
)
Your answer
Insert Resume (and send to
officeak@behaviormattersllc.com
)
Include dates of employment, company name, phone, address, job title, starting and end salary, responsibilities, employment dates, reason for leaving
Your answer
May we contact your previous supervisor(s) for a reference?
Yes
No
Other:
Clear selection
Disclaimer and Digital Signature
*
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. If you agree, please type your name below.
Your answer
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