Behavior Matters AK Job Application – S.T.A.G.E.S of Learning Center

AK Behavior Matters Job Application

* Required

Date *

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

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

If no, are you authorized to work in the USA? *

Yes

Have you ever worked for this company? *

Yes

If yes, when

YYYY

Have you ever been convicted of a felony? *

Yes

Education-Where did you attend? Dates?

Your answer

College- Did you graduate?

Yes

Clear selection

Education- Other

Your answer

Other- Did you graduate?

Yes

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

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

Submit

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